Plasma Connective Tissue Growth Factor Is an Independent Predictor of End-Stage Renal Disease and Mortality in Type 1 Diabetic Nephropathy

OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes. RESEARCH DESIGN AND METHODS Data from 3730 participants without end-stage renal disease at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER) participants were classified into those with normal AER, microalbuminuria, and macroalbuminuria. Progression from normal AER to either microalbuminuria, macroalbuminuria, or end-stage renal disease; or from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period was investigated. RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk [0.989 (0.982–0.997), P=0.008]. Dividing the sample based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those ≤36.5 years. CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.

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Comparison of the course to end-stage renal disease of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetic nephropathy

Diabetologia ◽

10.1007/bf02374504 ◽

1993 ◽

Vol 36 (10) ◽

pp. 1094-1098 ◽

Cited By ~ 35

Author(s):

J. A. Pugh ◽

R. Medina ◽

M. Ramirez

Keyword(s):

Diabetic Nephropathy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Insulin Dependent ◽

Insulin Dependent Diabetic ◽

Stage Renal Disease ◽

End Stage

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Depression is associated with progression of diabetic nephropathy in type 1 diabetes

10.2337/figshare.13073387.v1 ◽

2020 ◽

Author(s):

Aila J. Ahola ◽

Valma Harjutsalo ◽

Carol Forsblom ◽

François Pouwer ◽

Per-Henrik Groop ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Symptoms Of Depression ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage

OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes. RESEARCH DESIGN AND METHODS Data from 3730 participants without end-stage renal disease at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER) participants were classified into those with normal AER, microalbuminuria, and macroalbuminuria. Progression from normal AER to either microalbuminuria, macroalbuminuria, or end-stage renal disease; or from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period was investigated. RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk [0.989 (0.982–0.997), P=0.008]. Dividing the sample based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those ≤36.5 years. CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.

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Diabetic nephropathy

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.1521 ◽

2011 ◽

pp. 1935-1946 ◽

Cited By ~ 2

Author(s):

Janaka Karalliedde ◽

Giancarlo Janaka

Keyword(s):

Cardiovascular Disease ◽

Diabetic Retinopathy ◽

Diabetic Nephropathy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Albumin Excretion ◽

Stage Renal Disease ◽

End Stage

Diabetic nephropathy is classically defined as a rise in urinary albumin excretion rate (UAER), often associated with an increase in blood pressure, with concomitant retinopathy but without evidence of other causes of renal disease (1). It is characterized by a progressive decline in glomerular filtration rate (GFR), eventually resulting in end-stage renal disease. Diabetic nephropathy occurs in approximately 30–35% of type 1 and type 2 patients and tends to cluster in families. These families also show a predisposition to cardiovascular disease and hypertension—and, hypertension, or a predisposition to it, appears a major determinant of diabetic renal disease. These data taken together clearly suggest an individual susceptibility to this complication. The phases of diabetic nephropathy based on urine albumin excretion status and GFR are shown in Table 13.5.3.1 (2). Histological changes of diabetic glomerulopathy are present in over 95% of patients with type 1 diabetes and albuminuria (UAER >300 mg/day) and in approximately 85% of type 2 diabetic patients who develop albuminuria with concomitant diabetic retinopathy (1, 2). In the absence of diabetic retinopathy nearly 30% of patients with type 2 diabetes and proteinuria have nondiabetic renal lesions (1). The all-cause mortality in patients with diabetic nephropathy is nearly 20–40 times higher than that in patients without nephropathy. In recent years it has become apparent that renal disease and cardiovascular disease are closely related and diabetic nephropathy is acknowledged as an independent and powerful risk factor for cardiovascular disease (3). Many patients with diabetes and renal impairment die from a cardiovascular disease event before they progress to end-stage renal disease. Diabetic nephropathy is the most common cause of end-stage renal disease worldwide and represent about 30–40% of all patients receiving renal replacement therapy in the Western World.

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