Incidence of Nephropathy in IDDM as Related to Mortality. Costs and Benefits of Early Intervention

  • Knut Borch-Johnsen


Development of persistent proteinuria — the clinical manifestation of diabetic nephropathy — is a strong prognostic marker in IDDM-patients. Not only does it precede the development of end stage renal failure, it is also associated with an increased risk of proliferative retinopathy, visual impairment and blindness, and with an increased risk of atherosclerosis leading to peripheral vascular disease and amputations, coronary artery disease, myocardial infarction, Sudden death and cerebrovascular disease and stroke.


Diabetic Nephropathy Excess Mortality Persistent Proteinuria Overt Nephropathy Incipient Nephropathy 
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  1. 1.
    Andersen AR, Christiansen JS, Andersen JK, Kreiner S & Deckert T. Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: and epidemiological study. Diabetologia 1983;25:496–501.PubMedCrossRefGoogle Scholar
  2. 2.
    Kofoed-Enevoldsen A, Borch-Johnsen K, Kreiner S, Nerup J, Deckert T. Declining incidence of persistent proteinuria in Type 1 (insulin-dependent) diabetic patients in Denmark. Diabetes 1987;36:205–209.PubMedCrossRefGoogle Scholar
  3. 3.
    Krolewski AS, Warram JH, Christlieb ARE, Busick EJ, Kahn CR. The changing natural history of nephropathy in Type 1 diabetes. Am J Med 1985;78:785–794.PubMedCrossRefGoogle Scholar
  4. 4.
    Tchobroutsky G. Relation of diabetic control to development of microvascular complications. Diabetologia 1978;15:143–153.PubMedCrossRefGoogle Scholar
  5. 5.
    Bojestig M, Amqvist HJ, Hermansson G, Karlberg BE, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med 1994;330:15–18.PubMedCrossRefGoogle Scholar
  6. 6.
    Mortensen HB, Hougaard P. Comparison of metabolic control in a cross-sectional study of 2,873 children and adolescents with IDDM from 18 countries. Diabetes Care 1997;20:714.PubMedCrossRefGoogle Scholar
  7. 7.
    Rossing P, Rossing K, Jacobsen P, Parving HH. Unchanged incidence of diabetic nephropathy in IDDM patients. Diabetes 1995;44:739–743.PubMedCrossRefGoogle Scholar
  8. 8.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986.CrossRefGoogle Scholar
  9. 9.
    Borch-Johnsen K. The prognosis of insulin-dependent diabetes mellitus. Dan Med Bull 1989;36:336–348.PubMedGoogle Scholar
  10. 10.
    Diabetes Epidemiology Research International (DERI) Mortality Study Group. Major Cross-Country differences in risk of dying for people with IDDM Diabetes Care 1991;14:49–54.Google Scholar
  11. 11.
    Watson PJ, Blainey JD, Brewer DB, Fitzgerald MG, Malins JM, O’SulIivan DJ, Pinto JA. The natural history of diabetic renal disease. Q J Med 1972;164:437–456.Google Scholar
  12. 12.
    Borch-Johnsen K, Andersen PK, Deckert T. The effect of proteinuria on relative mortality in Type 1 (msulm-dependent) diabetes mellitus. Diabetologia 1985;28:590–596.PubMedCrossRefGoogle Scholar
  13. 13.
    Parving HH, Hommel E. Prognosis in diabetic nephropathy. BMJ 1989;299:230–233.PubMedCrossRefGoogle Scholar
  14. 14.
    Rossing P, Hougaard P, Borch-Johnsen K, Parving HH. Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study. BMJ 1996;313:779–784.PubMedCrossRefGoogle Scholar
  15. 15.
    Jensen T, Borch-Johnsen K, Deckert T. Coronary heart disease in young Type 1 (insulin-dependent) diabetic patients with diabetic nephropathy: Incidence and risk factors. Diabetologia 1987;30:144–148.CrossRefGoogle Scholar
  16. 16.
    Borch-Johnsen K, Kreiner S. Proteinuria: value as predictor of cardio-vascular mortality in insulin-dependent diabetes mellitus. Br Med J 1987;294:1651–1654.CrossRefGoogle Scholar
  17. 17.
    Borch-Johnsen K, Kreiner S, Deckert T. Mortality of Type 1 (insulin-dependent) diabetes mellitus in Denmark. Diabetologia 1986;29:767–772.PubMedCrossRefGoogle Scholar
  18. 18.
    Viberti GC, Jarrett RJ, Mahmud U, Hill RD, Argyropoulos A, Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulin dependent diabetes mellitus. Lancet 1982; i: 1430–1432.CrossRefGoogle Scholar
  19. 19.
    Mogensen CE, Christensen CK. Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 1984;311:89–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Mathiesen ER, Oxenboll B, Johansen K, Svendsen PAa, Deckert T. incipient nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 1984;26:406–410.PubMedCrossRefGoogle Scholar
  21. 21.
    Jensen T. Albuminuria — a marker of renal and generalized vascular disease in insulin-dependent diabetes mellitus. Dan Med Bull 1991;38:134–144.PubMedGoogle Scholar
  22. 22.
    Feldt-Rasmussen B. Microalbuminuria and clinical nephropathy in Type 1 (insulin-dependent) diabetes mellitus: pathophysiological mechanisms and intervention studies. Dan Med Bull 1989;36:405–415.PubMedGoogle Scholar
  23. 23.
    Gall M-A, Borch-Johnsen K, Hougaard P, Nielsen FS, and Parving H-H. Albuminuria and poor glycemic control predict mortality in NIDDM. Diabetes 1995 ;44:1303–1309.Google Scholar
  24. 24.
    Agewall S, Wikstrand J, Ljungman S, Herlitz H, and Fagerberg B. Does microalbuminuria predict cardiovascular events in nondiabetic men with treated hypertension? AJH 1995;8:337–342.PubMedGoogle Scholar
  25. 25.
    Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 1984;310:356–360.PubMedCrossRefGoogle Scholar
  26. 26.
    Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ. Microalburninuria predicts mortality in non-insulin-dependent diabetes. Diabetic Med 1984;1:17–19.PubMedCrossRefGoogle Scholar
  27. 27.
    Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1988; ii:530–533.CrossRefGoogle Scholar
  28. 28.
    Damsgaard EM, Frøland A, Jørgensen OD, Mogensen CE. Micro-albuminuria as predictor of increased mortality in elderly people. BMJ 1990;300:297–300.PubMedCrossRefGoogle Scholar
  29. 29.
    Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS. Microalbuminuria: a novel independent risk factor for ischemic heart disease. Submitted BMJ 1997.Google Scholar
  30. 30.
    Messent JWC, Elliott TG, Hill RD, Jarrett RJ, Keen H, Viberti GC. Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty year follow-up study. Kidney Int 1992;41:836–839.PubMedCrossRefGoogle Scholar
  31. 31.
    Deckert T, Yokoyama H, Mathiesen ER, Rann B, Jansen T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen JS. Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in insulin dependent diabetes. BMJ 1996;312:871–874.PubMedCrossRefGoogle Scholar
  32. 32.
    Marre M, Chatellier G, Leblanc H, Guyene TT, Menard J, Passa P. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ 1988;297:1092–1095.PubMedCrossRefGoogle Scholar
  33. 33.
    Mathiesen ER, Hommel E, Giese J, Parving H-H. Efficacy of Captopril in postponing nephropathy in normotensive insulin-dependent diabetic patients with microalbuminuria. BMJ 1991;303:81–87.PubMedCrossRefGoogle Scholar
  34. 34.
    Melbourne Diabetic nephropathy study group. Comparison between Perindopril and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. BMJ 1991;302:210–216.CrossRefGoogle Scholar
  35. 35.
    Viberti GC, Mogensen CE, Groop L, Pauls JF for the European Microalbuminuria Captopril Study Group. Effect of Captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. JAMA 1994;271:275–279.CrossRefGoogle Scholar
  36. 36.
    Sawicki PT, Mühlhaser I, Bender R, Pethke W, Heinemarm L, Berger M. Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy. J Mem Med 1996;239:345–352.Google Scholar
  37. 37.
    Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH. The effect of dietary protein restriction on the progression of diabetic and non-diabetic renal disease: a meta-analysis. Arm Intern Med 1996;124:627–632.CrossRefGoogle Scholar
  38. 38.
    Eggers PW. Health Care Policies/economics of the geriatric renal population. Am J Kidney Dis 1990;16:384–391.PubMedGoogle Scholar
  39. 39.
    Siegel JE, Krolewski AS, Warram JH, Weinstein MC. Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus. J AM Soc Nephrol 1992;3:3111–3119.Google Scholar
  40. 40.
    Borch-Johnsen K, Wenzel H, Viberti GC, Mogensen CE. Is screening and intervention for Microalbuminuria worthwhile in patients with insulin dependent diabetes? BMJ 1993;306:1722–1725.PubMedCrossRefGoogle Scholar
  41. 41.
    Ramlau-Hansen H, Bang Jespersen NC, Andersen PK, Borch-Johnsen K, Deckert T. Life insurance for insulin-dependent diabetics. Scand Actuarial J 1987;19–36.Google Scholar
  42. 42.
    Feldt-Rasmussen B, Mathiesen ER, Jensen T, Lauritzen T, Deckert T. Effect of improved metabolic control on loss of kidney function in Type 1 (insulin-dependent) diabetic patients: an update of the Steno studies. Diabetologia 1991;34:164–170.PubMedCrossRefGoogle Scholar
  43. 43.
    Parving H-H, Andersen ARE, Smidt UM, Svendsen PAA Early aggressive antihypertensive treatment reduces the rate of decline in kidney function in diabetic nephropathy. Lancet 1983; i:1175–1179.CrossRefGoogle Scholar
  44. 44.
    Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T. Improved survival in patients with diabetic nephropathy. Diabetologia 1989;32:884–886.PubMedCrossRefGoogle Scholar
  45. 45.
    Kiberd BA, Jindal KK. Screening to prevent renal failure in insulin dependent diabetic patients: an economical evaluation: BMJ 1995;311:595–599.Google Scholar
  46. 46.
    Microalbuminuria Collaborative Study Group, UK. Risk factors for development of microalbuminuria in insulin dependent diabetic patients: a cohort study. BMJ 1993;306:1235–1239.CrossRefGoogle Scholar
  47. 47.
    Hansen KW, Christensen CK, Andersen PH, Mau Pedersen M, Christiansen JS, Mogensen CE. Ambulatory blood pressure in microalbuminuria type 1 diabetic patients. Kidney Int 1992;41:847–854.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Knut Borch-Johnsen
    • 1
  1. 1.Steno Diabetes CentreGentofteDenmark

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