Zaharah Abdul Rahman

915 STRATIFICATION OF RISK FACTORS FOR NEPHROPATHY IN HYPERTENSIVE DIABETICS

Objectives: Significant proportion of diabetics develop nephropathy in time and hypertension is considered as an adverse influencing factor.The aim was to identify risk factors related to possible deterioration in renal function among Bangladeshi type 2 diabetic hypertensive (DH) subjects. Method: Diabetic subjects with normal renal function (estimated GFR ≥60 ml/min and urinary albumin <30 mg/day) were included in this cross sectional study. Hypertension was taken as BP ≥140/90mmHg when untreated or taking ≥2 antihypertensives. Results: In DH group 342 and another 496 normotensive diabetic (DM) as control group were included. The comparisons between 2 groups respectively showed systolic BP 130 ± 14 vs. 118 ± 11 and diastolic BP 80 ± 7 vs. 76 ± 6, mmHg; (p < 0.001). The diabetes duration was 8 ± 5 vs. 8 ± 4 yrs, HbA1c 8.1 ± 1.8 vs. 7.1 ± 1.3, %; Serum creatinine (SCr) 0.9 ± 0.1 vs. 0.9 ± 0.2, mg/dl and LDL 103 ± 35 vs. 99 ± 37, mg/dl; (P =NS) were similar. The differences in 2 groups, though mostly clinically less significant, were for age 55 ± 8 vs. 53 ± 8 yrs, (p < 0.001); BMI 25 ± 4 vs. 24 ± 2 kg/m2, (p < 0.03); 24hr urinary albumin (Uralb) 10.9 ± 6.4 vs. 9.6 ± 6.4 mg/day (p < 0.01) and estimated GFR 80 ± 20 vs. 84 ± 21 ml/ming/1.73m2, (p < 0.004). Bivariate correlations showed only age had a negative association with SCr, Uralb and eGFR. Further stratification showed around 65% from both DH and DM groups was in the lower range of eGFR (60-90 ml/min).When DH group was compared for eGFR above and below 90 ml/min (33 vs. 67%), no difference was seen for most of the clinical or laboratory parameters (systolic 129 ± 12 vs. 130 ± 14 & diastolic BP 80 ± 7 vs. 79 ± 7, mmHg; and SCr 0.7 ± 0.1 vs. 0.9 ± 0.1, mg/dl; p = NS) Conclusion: It is found that majority of type 2 diabetics with hypertension had lower normal renal function which could only be identified by estimating GFR. Both groups of high and low renal function had similar traditional clinical and laboratory parameters. Additional tools are needed to stratify which of the hypertensives are more at risk for developing nephropathy.