Proteinuria increases mortality risk for type 2 diabetic patients
 

proteinuria
Too much protein in the urine. This may be a sign of kidney damage.

Note: Eating protein does not cause proteinuria.

Diabetes Week
Publisher: CW Henderson
Issue: August 5, 2002
Page: 3

Prognosis
Proteinuria increases mortality risk for type 2 diabetic patients

2002 AUG 5 - (NewsRx.com) -- by Maria G. Essig, MS, ELS, senior medical writer - Proteinuria was a strong predictor of mortality, independent of other risk factors, in patients with type 2 diabetes, according to researchrs in the U.K.

"The causes and mechanisms of increased mortality of patients with diabetic nephropathy are unclear, and its natural history is poorly understood," commented E.B. Jude and colleagues at Manchester University.

The investigators used data from a secondary care register to perform a retrospective study of 170 type 2 diabetes patients who exhibited nephropathy, defined as proteinuria greater than 0.5 g/24 h, and 170 control subjects without nephropathy. Follow-up time was from 2-10 years (average of 5.3 years) or until death.

Patients with nephropathy at baseline were significantly more likely to die within the follow-up period than were the control subjects (37% vs. 8%, respectively; p<0.0001). After adjusting for age and sex, the mortality from all causes was 8.1 deaths/100 person-years for test subjects compared with 1.4 deaths/100 person-years for control subjects (rate ratio 5.8).

A proportional correlation existed between mortality and the amount of proteinuria, with 4.6 deaths/100 people-years for proteinuria 0.5-2 g/24 h, to 9.9 deaths/100 people-years for proteinuria greater than 2 g/24 h. Each log increase in proteinuria amount was associated with a 36% greater risk of death; patients with nephropathy were 5 times more likely to die from cardiovascular complications and all other causes than were control subjects.

Other risk factors for mortality included baseline age, creatinine levels, and degree of glycemic control (Natural history and prognostic factors of diabetic nephropathy in type 2 diabetes. QJM - Monthly Journal of the Association of Physicians, 2002;95(6):371-377).

"Proteinuria is a potentially preventable and reversible risk factor associated with high mortality in type 2 diabetic patients," concluded Jude and coauthors. "Prevention of the development of overt nephropathy and improvement in diabetes control may reduce mortality in these patients,"

The corresponding author for this study is E.B. Jude, Tameside General Hospital, Diabetes Centre, Fountain Road, Ashton-under-Lyne, Lancashire OL6 9RW, UK. E-mail: ejude~man.ac.uk.

Key points reported in this study include:

• Type 2 diabetic patients with proteinuria had a significantly higher mortality rate than those without proteinuria.

• The mortality rate of type 2 diabetic patients was directly proportional to the amount of proteinuria - as proteinuria increased, so did mortality rate.

• Other risk factors that increased mortality rate included higher baseline age, increased creatinine, and poor glycemic control.

This article was prepared by Diabetes Week editors from staff and other reports. Copyright 2002, Diabetes Week via NewsRx.com.

Diabetic Nephropathy, Albuminuria and the role of Protein

Proteinuria is more accurately called albuminuria, since albumin is the protein that's being excreted in the urine and consequently measured. Albumin is a normal protein constituent of blood -- and when kidneys are damaged due to some pathology or disease, they will allow albumin to leak out into the urine. As kidney disease progresses, the rate at which albumin is lost will increase. This is true whether the kidney disease is caused by diabetes or by some other means, such as infection, reduced blood flow (due to massive blood loss, severe burns or shock), or alcoholism.

So, it stands to reason, as the above study shows, that the amount of albumin being excreted in the urine is an accurate indicator of the severity of the nephropathy. Or simply, the more albumin being excreted, the worse the kidney damage, and thus greater mortality risk.

In the case of diabetes, the cause of nephropathy (kidney damage) is due to high blood sugars that are inadequately controlled. High blood pressure is also a contributing factor, as are high insulin levels ... whether injected to cope with high blood sugars in Type 1, or due to insulin resistance in Type 2.

Eating protein will not cause nephropathy/ kidney damage .. not in diabetics, not in non-diabetics. When the kidneys are already damaged however, eating excessive protein can contribute to an increase in the amount of albumin that's excreted. Also when kidneys are damaged, they become less and less able to filter out the by-products that are created when protein is metabolized in the body .. namely urea and creatinine. Consequently, these by-products accumulate in the blood, to toxic levels. For this reason, patients with kidney disease are often put on a protein-restricted diet.

In Dr. Bernstein's Diabetes Solution, he explains how important it is to get blood sugars not just under control but down to normal (ie, non-diabetic) levels, and keep them there. This is best achieved with a low-carb diet, with higher protein and fat intake, in addition to insulin and/or medication to reduce insulin-resistance. He completely reversed his own nephropathy, and has seen it in numerous patients. Bernstein has posted some chapters from the book on his website, www.diabetes-normalsugars.com. For a detailed explanation of diabetic nephropathy and the role of protein and fat ... check out Appendix A, Page 2 and Page 3

Doreen

wow wonderful info. ty Doreen :) have put that site on my favorites and will study it more indepth later.

rick