The role of glycemia and blood pressure control on the rate of decline in glomerular filtration rate in Vietnamese type 2 diabetes patients

The rate of decline in glomerular filtration rate (a dagger a dagger"GFR), commonly used to evaluate the progression of chronic kidney disease (CKD), varies considerably among type 2 diabetes subjects. The determinants of the variability especially hyperglycemia and hypertension are not consistent. We present a retrospective cohort study [450 out of 536 patients with type 2 diabetes who did not have renal insufficiency at baseline (estimated GFR a parts per thousand yenaEuro parts per thousand 60 ml/min/1.73 m(2))]. We examined factors affecting progression of a dagger a dagger"GFR as an endpoint using linear regression analysis. The mean a dagger a dagger"GFR was 2.3 (SD 2.9) mL/min/1.73 m(2)/year. Univariate analysis showed that this was associated with mean HbA1c (P = 0.004), mean systolic blood pressure (BP) (P < 0.001), and mean pulse pressure (P < 0.001). Hazard ratio (HR) of the appearance of renal insufficiency was significantly higher in the group with mean systolic BP a parts per thousand yenaEuro parts per thousand 130 mmHg (HR = 3.0, P < 0.001) and mean pulse pressure a parts per thousand yen 50 mmHg (HR = 3.7, P < 0.001). In subjects with type 2 diabetes, glycemia and BP control play an important role on slowing the rate of decline in kidney function. Higher systolic BP and pulse pressure, but not diastolic BP, are significantly associated with increased a dagger a dagger"GFR.