| Objective:To evaluate the albuminuria degree and the kidney function status of out-patients with type 2 diabetes in endocrine clinic.To investigate the prevalence of diabetic nephropathy in this population. The situations on administering antihyperglycemia and antihypertention medication were analyzed. Satisfaction degree on metabolic marker control was investigated. Relative risk factors of chronic kidney were studied.Methods:Unified epidemiology questionnaire was performed. Application of antihyperglycemia and antihypertention medication was recorded. Data of anthropometric parameters, blood pressure, urine routine test, urinary albumin-to-creatinine ratio(ACR), biochemical markers of blood glucose, and lipid profiles were collected. metabolic markers were compared by groups which were divided according to the degree of albuminruia. Glomerular filtration rate(GFR) was estimated through Cockcroft-Gault(CG)/BAS equation and.Modification of Diet in Renal Disease study(MDRD) equation. Stage of chronic kidney disease(CKD) was evaluated by the practice guidelines of K/DOQI. Diabetic retinopathy disease was judged by professional oculists.Results:An out-patient population of 1200 case with type 2 diabetes was investigated. Integrative data was collected in 923 subjects, whose average age was 63 years old. Positive albuminuria was found in 397 cases(43.0%), among which 281 cases(30.4%)had microalbuminuria and116 cases(12.6%)had clinical albuminuria. The prevalence of diabetic nephro-pathy in this population was 43.0%. The case number of patients with CKD stage1, stage2, stage3 and stage4/5 was163 (17.7%),381 (41.3%),323 (34.9%) and 56 (6.1%). using CG/BSA equation. The case number of patients with CKD stage1, stage2, stage3 and stage4/5 was 414(44.9%), 352(38.1%),106(11.5%) and 51(5.5%)by MDRD equation.79.5% patients with negtive proteinuria had abnormal GFR caculated by CG/BSA equation, among them 34.2% are defined as kidney dysfunction 50.2% patients with negtive proteinuria had impaired GFR caculated by MDRD formula, among them 13.1% are defined as kidney dysfunction. This study of clinical practice, and more inclined to evaluate the application of MDRD method of renal function.According to the degree of albuminuria subjects were divided into three groups:negative albuminuria group, microalbuminuria group and clinical albuminuria group. GFR was used to evaluate kidney function which was estimated by MDRD equation. The prevalence of kidney dysfunction in negative albuminuria group, microalbuminuria group and clinical albuminuria group was 13.1%,14.2% and 40.3% respectively. After taking into consideration the influence of age, gender and duration of diabetic history, patients with positive albuminuria had higher systolic pressure, total cholesterol, triglyceride, lower density lipoprotein cholesterol and fasting blood glucose compared to patients with negative albuminria through covariance analysis. Age, degree of retiopathy and hypertension history are the independent risk factors of kidney dysfunction by multiple Logistic regression.923 cases of diabetes, as judged by glycated hemoglobin, blood sugar control overall satisfaction rate (20.1%). Statistics show that albuminuria-negative group than in the MDRD formula GFR≧90 ml/min/1.73m2 populations of oral antidiabetic drugs alone 298 patients,175 patients with simple glucose insulin, oral hypoglycemic insulin combined 69 cases, three glycosylated Hemoglobin compliance rates were 19.4%,17.4%,27.4%.923 cases of proteinuria in diabetic patients than the negative group MDRD GFR=90 ml/min/1.73m2 calculated populations of only one anti-hypertensive drug therapy of 277 cases, with two or more antihypertensive drugs in 71 cases, two blood pressure compliance rates were 21.6% and 25.4%. Monotherapy followed by the percentage of blood pressure compliance CCB 29.2%;β-blockers 22.2%; medicine or compound 20.1%; ACEI or ARB 13.3%; diuretics 10.0%. In this study 397 patients had microalbuminuria or albuminuria, in which only 22 cases took ACEI or ARB.Subjects were divided in three groups:positive albuminuria group, microalbuminuria group and clinical albuminuria group. Blood pressure control satisfaction rates are 44.2%,35.3% and 36.3% in the three groups. HbAlc control satisfaction rate is 22.2%,18.5 and15.2% in three groups. Triglyeride control satisfaction rate is 44.4%,43.3% and 39.8%. Total cholesterol control satisfaction rate is 34.5%,26.8% and 25.7%. LDL-c control satisfaction rate is 30.6%,23.8% and 22.1%. Examination of ocular fundus was undertaken in 707 cases. Prevalence of proliferative phrase lesion is 3.8%,6.7% and 17.6% in positive albuminuria group, micro-albuminuria group and clinical albuminuria group.Conclusion:The prevalence of diabetic nephropathy was 43.0% in this study in terms of diagnosis albumin excretion rate. The prevalence of kidney dysfunction was 41.0% and 17.0% caculated by CG/BSA equation and MDRD formula respectively. More than half subjects with negative albuminuira had impaired kidney function, no matter which equation was chosen. Endocrine doctors should pay attention to abuminuria test as well as kidney function evalution in diabetic population. Patients with positive albuminuria had more metabolic abnormalities. The satisfaction rate of controlling in blood glucose, serum lipid and blood pressure was relatively low. Antihypertention medication was not used by standard in our population. The ratio of using ACEI or ARB was low.
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