Original research| Volume 9, ISSUE 1, P31-38, February 2015

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High prevalence of chronic kidney disease in Finnish patients with type 2 diabetes treated in primary care



      To examine the prevalence of chronic kidney disease (CKD) and related cardiovascular morbidity in a cross-sectional population in patients with type 2 diabetes (T2D) treated in a primary care setting in Finland.

      Research design and methods

      Data were collected and recorded from 42 primary care centres, which recruited 629 patients diagnosed with type 2 diabetes (T2D) to this non-interventional study. Data including patient characteristics, kidney function and albuminuria, blood pressure, HbA1c, lipid and lipoprotein levels, and diabetes duration as well as current medication was collected in each patient.


      In the final study population of 625 patients, the mean age was 67 years (range 29–92 years), BMI 32.8 kg/m2 (95% CI 32–33), blood pressure 142/80 mmHg (140–143/80–81) and HbA1c 7.1% (7.0–7.2) (53.8 mmol/mol, 53–55) and the median duration of diabetes was 9.2 years ranging from newly diagnosed to 43 years. History of dyslipidemia had in 73.3% of patients, 27.8% had cardiovascular disease and 82.7% had hypertension. The primary endpoint, prevalence of CKD of any grade (1–5) or albuminuria, was 68.6%. Regarding declined renal function, 16.2% of patients had an estimated glomerular filtration rate (eGFR) <60 ml/min/1.72 m2, classifying as CKD 3–5. Only one patient was within CKD5. Regarding renal damage, albuminuria was present in 24.3% of patients, with microalbuminuria in 17.1% and macroalbuminuria in 7.2%, respectively. Combining the patients with CKD 3–5 and/or the presence of albuminuria, 34.7% seemed to suffer from significant CKD. The proportion of patients with albuminuria increased with a decrease in glomerular filtration rate. Historically, diabetic nephropathy had been diagnosed in 24.3% of the patients.


      Nearly 70% of patients with T2D treated in primary care in Finland have some sign of CKD and nearly half of all T2D patients have a significant CKD. However, only half of the latter had it diagnosed and documented in their patient charts, thus highlighting the importance of performing routine screening of nephropathy by measuring both albuminuria and eGFR in patients with T2D. Prevention of this complication with active therapy for risk factors, such as hypertension and dyslipidemia is warranted.
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        • IDF
        Diabetes Atlas 2012.
        5th ed. 2012
      1. Koski S.

      2. Current Care Guideline for Diabetes. Working group appointed by the Finnish Medical Society Duodecim and the Medical Advisory Board of the Finnish Diabetes Society.

        • Kastarinen M.
        • Juutilainen A.
        • Kastarinen H.
        • et al.
        Risk factors for end-stage renal disease in a community-based population: 26-year follow-up of 25 821 men and women in Eastern Finland.
        J. Intern. Med. 2010; 267: 612-620
        • Chronic Kidney Disease Prognosis Consortium
        Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
        Lancet. 2010; 375: 2073-2081
        • Koro C.E.
        • Lee B.H.
        • Bowlin S.J.
        Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States.
        Clin. Ther. 2009; 31: 2608-2617
        • Wadén J.
        • Forsblom C.
        • Thorn L.M.
        • Gordin D.
        • Saraheimo M.
        • Groop P.H.
        • Finnish Diabetic Nephropathy Study Group
        A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes.
        Diabetes. 2009; 58: 2649-2655
      3. National Kidney Foundation K/DOQI kidney disease outcome quality initiative.
        Am. J. Kidney Dis. 2002; 39: S1-S266
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Adv. Intern. Med. 2009; 150: 604-612
        • Daniel W.W.
        Biostatistics: A Foundation for Analysis in the Health Sciences.
        7th ed. John Wiley & Sons, New York1999
        • Merker L.F.
        • Gallwitz B.
        • Waldeck B.
        • Schoene K.
        Prevalence of chronic kidney disease in type 2 diabetes. Results from a nationwide survey in Germany.
        Diabetologia. 2012; 55: S160
        • Niskanen L.K.
        • Penttilä I.
        • Parviainen M.
        • Uusitupa M.I.
        Evolution, risk factors, and prognostic implication of albuminuria in NIDDM.
        Diabetes Care. 1996; 19: 486-493
        • Adler I.A.
        • Stevens R.J.
        • Manley S.E.
        • Bilous R.W.
        • Cull C.A.
        • Holman R.R.
        • on behalf of the UKPDS Group
        Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64).
        Kidney Int. 2003; 63: 225-232
        • Peltonen M.
        • Korpi-Hyövälti E.
        • Oksa H.
        • Puolijoki H.
        • Saltevo J.
        • Vanhala M.
        • Saaristo T.
        • Saarikoski L.
        • Sundvall J.
        • Tuomilehto J.
        Lihavuuden, diabeteksen ja muiden glukoosiaineenvaihdunnan häiriöiden esiintyvyys suomalaisessa aikuisväestössä. Dehkon 2D hanke (D2D).
        Suom. Laakaril. 2006; 61: 163-170
        • Chuatrun T.
        • Simon J.
        • Hudson C.
        • et al.
        Cigarette smoking exacerbates and its cessation ameliorates renal injury in type 2 diabetes.
        Am. J. Med. Sci. 2004; 325: 57-67
        • Athyros V.G.
        • Katsiki N.
        • Doumas M.
        • Karagiannis A.
        • Mikhailidis D.P.
        Effect of tobacco smoking and smoking cessation on plasma lipoproteins and associated major cardiovascular risk factors: a narrative review.
        Curr. Med. Res. Opin. 2013; 10: 1263-1274
        • de Zeeuw D.
        • Remuzzi C.
        • Parving H.H.
        • et al.
        Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy.
        Circulation. 2004; 110: 921-927
        • Mann J.F.E.
        • Schmieder R.E.
        • MqGueen M.
        • et al.
        • for the ONTARGET study investigators
        Renal outcomes with telmisartan, ramipril, or both in people at high vascular risk.
        Lancet. 2008; 372: 547-553
        • KDOQI clinical practice guideline for diabetes and CKD: 2012 update
        Am. J. Kidney Dis. 2012; 60: 850-886
        • Baigent C.
        • Landray M.J.
        • Reith C.
        • et al.
        The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial.
        Lancet. 2011; 377: 2181-2192