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Effect on Renal Function After 6 Years of Follow-up

Ruby Meiland, MD, PhD; Suzanne E. Geerlings, MD, PhD; Ronald P. Stolk, MD, PhD; Patrick M. Netten, MD; Peter M. Schneeberger, MD, PhD; Andy I. M. Hoepelman, MD, PhD

Arch Intern Med. 2006;166:2222-2227.

Background  The long-term consequences of asymptomatic bacteriuria (ASB) on renal function in women with diabetes mellitus (DM) are unknown.

Methods  A prospective study was performed among women with type 1 or type 2 DM. Women with ASB (diagnosis based on findings from 1 urine culture specimen) were compared with women without ASB for differences in renal function development and incidence of hypertension.

Results  A total of 644 women were included in the study (296 with type 1 DM and 348 with type 2 DM; mean [SD] age, 51 [15] years) and followed up for a mean (SD) duration of 6.1 (1.9) years. The prevalence of ASB was 17%. In women with DM and ASB, the creatinine clearance decreased from 87 mL/min (1.45 mL/s) at baseline to 76 mL/min (1.27 mL/s) at study end point; in women with DM without ASB the creatinine clearance decreased from 97 to 88 mL/min (from 1.62 to 1.47 mL/s). In the multivariate analyses, adjusted for age, length of follow-up, duration of DM, and microalbuminuria at baseline, no association was found between ASB and the relative or the absolute decrease in creatinine clearance; the same results were shown also when women with DM type 1 and women with DM type 2 were analyzed separately. Women with ASB developed hypertension more often than women without ASB (54% vs 37%; P = .045), but there was no significant association in the multivariate analysis (odds ratio, 1.5; 95% confidence interval, 0.7-3.6).

Conclusion  Women with DM (type 1 or type 2) with ASB do not have an increased risk for a faster decline in renal function or the development of hypertension after 6 years of follow-up.

Author Affiliations: Department of Internal Medicine and Infectious Diseases, Eijman-Winkler Center for Microbiology and Infectious Diseases (Drs Meiland and Hoepelman), and Julius Center for Health Sciences and Primary Care (Dr Stolk), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Infectious Diseases, Tropical Medicine, and AIDS, Academic Medical Center, Amsterdam, the Netherlands (Dr Geerlings); Department of Epidemiology and Bioinformatics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Dr Stolk); and Department of Internal Medicine (Dr Netten) and Laboratory of Medical Microbiology (Dr Schneeberger), Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.

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