Non-proteinuric diabetic nephropathy is the main cause of chronic kidney disease: Results of a general population survey in Spain

Background: Diabetic nephropathy traditionally produces significant proteinuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. The current study evaluated the impact of diabetes mellitus on the prevalence of renal disease in general population. Methodology: Data from of the HERMEX survey, an observational, cross sectional, population based study were used. The final sample included 2813 subjects (mean age 51.2 years, 53.5% female). Four hundred patients have diabetes. Urinary albumin excretion (UAE) rate was analyzed and glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. Results: Among participants without diabetes, 2.9%(2.2-3.6) had a GFR < 60 ml/min. Prevalence of abnormal UAE in population without diabetes was 3.3% (2.6-4.0). The global prevalence of renal disease was 5.6%(4.8-6.6). Prevalence of GFR < 60 ml/min in subjects with diabetes was 8.8%(6.4-11.9)(p < 0.001, Chi-square test). Prevalence of abnormal UAE in population with diabetes was 14.1%(7.7-19.8)(p < 0.001, Chi-square test). CKD prevalence was 20.3%(16.6-24.6)(p < 0.001, Chi-square test). The logistic regression analysis showed a positive independent association of CKD with age, high blood pressure and albuminuria. No significant relationship was found with diabetes mellitus. Conclusions: CKD is more prevalent in population with diabetes. Nevertheless, most of patients with diabetes and CKD have no albuminuria. An increased cardiovascular burden seems to produce this clinical presentation. (C) 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.