Diabetic Kidney Disease and Hypertension: A True Love Story

INTRODUCTION: Diabetes Mellitus (DM) remains one of the commonest causes of structural and functional kidney abnormalities leading to End Stage Renal Disease (ESRD). The next most common cause is hypertension. It is utmost important to investigate the association between diabetic nephropathy and hypertension because it is a major causal factor of end-stage kidney failure in Type 2 Diabetes Mellitus (T2DM). AIM: The aim of the present study was to investigate the association between albuminuria, hypertension and estimated glomerular filtration rate (eGFR) in a prospective cohort of T2DM patients in a developing country. MATERIALS AND METHODS: A total of 824 patients were enrolled from a tertiary healthcare center in central India. This study was performed in three groups: normal controls (232), type 2 diabetics without nephropathy (185) and type 2 diabetics with nephropathy (407). Diabetic nephropathy was clinically defined by the presence of persistent proteinuria of > 500mg/day in a diabetic patient in the absence of clinical or laboratory evidence of other kidney or urinary tract disease. Hypertension was categorized based on JNC 7 classification. Detailed clinical history was obtained from all subjects. Student's t-test was applied to see the difference in mean values of quantitative data in two groups. Chi-Square test was applied to see the difference in frequency of discrete variables in two groups. RESULTS: A 66.3% diabetic nephropathy patients and 51.9% type 2 diabetics without nephropathy were found hypertensive in present study; In contrast only 14.7% controls had hypertension. No association of hypertension was found with age and gender in either group. Serum creatinine and eGFR was found significantly different in hypertensive diabetic nephropathy patients than normotensive (p=0.002 and <0.0001 respectively). CONCLUSION: Our study found that hypertension was an independent risk factor for the Diabetic Kidney Disease (DKD). Along with this, a proportional increase in the level of serum creatinine and eGFR was seen with an incidence of hypertension in diabetic nephropathy.