Background: Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to\nprevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN)\nshare common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in\npatients with Type 2 diabetes.\nMethods: A prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded.\nFoot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular\nfiltration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine\nratio (ACR) >3.4 mg/mmol.\nResults: Two hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred\nand ninety patients (83.4%) had eGFR ââ?°Â¥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity\n(i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of\nalbuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity,\ndiabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular\ndisease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = âË?â??3.551, p = 0.036).\nConclusions: Patients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these\npatients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of\nCKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic\nperformance of our findings in predicting CKD development, and to compare the performance of the monofilament test\nwith albuminuria.
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