A JournAl of the AmericAn DiAbetes AssociAtion

Acute and Chronic ComplicationsComplications—NephropathyWithdrawn5-LBlikelihood of identification of CKD based on practice setting, number of yearsin practice, or self-reported numbers of patients seen per week.CKD is significantly under-diagnosed in the T2DM population. Additionalanalyses will explore the impact of CKD detection on the implementation ofevidence-based CKD interventions and outcomes.Complications—Neuropathy6-LBLoss of Kidney Respiratory Activity in Type 1 Diabetic MiceCorrelates with Development of NephropathyTATYANA VOTYAKOVA, ANN PICCIRILLO, MASSIMO TRUCCO, Pittsburgh, PADiabetes mellitus causes a number of complications, in particular, diabeticnephropathy. Persistent hyperglycemia and polyuria put a huge energeticburden on kidneys which require a robust mitochondrial performance. Theaim of this study was to investigate whether mitochondrial mechanisms areinvolved into development of nephropathy in conditions of Type 1 Diabetes.We used diabetic mice of two strains (B6 and DBA) with the same mutationin Ins2 gene (the Akita mice) and age matched wild type (WT) controls. TheAkita mice of both stains became hyperglycemic at 4 weeks, had profoundpolyuria and increased kidney mass as compared to WT controls. At the age of24 weeks DBA-Akita, but not B6-Akita, mice developed profound albuminuriasymptomatic of nephropathy. Respiratory activity of kidney homogenateswith a number of mitochondrial substrates for Complex I and Complex II weremeasured. Tests with specific mitochondrial drugs showed that in kidneyhomogenates mitochondria are responsible for 98% of O2 consumptionand well coupled. This approach allowed assessing mitochondrial activitynormalized by tissue mass and to characterize energetic status of kidneyas a whole. Respiratory activities of kidneys from 8 week old Akita mice ofboth strains were equal or up to 20% higher as compared to respective WTcontrols, apparently, to compensate for diabetic metabolic derangements. Inaged 24 week old mice mitochondrial activity of kidneys from B6-Akita micewere still close to that of control group, while kidney mitochondrial activityfrom DBA-Akita mice dropped 5-20% depending on substrate (succinate andb-HOB most of all). Additionally, kidney mitochondria of aged DBA-Akita, butnot B6-Akita, mice had elevated levels of Mn-SOD indicating higher level ofoxidative stress. In conclusion, despite similar levels of hyperglycemia, DBA-Akita mice had more profound kidney dysfunction in form of albuminuriawhich was accompanied by loss in respiratory activity and symptoms ofoxidative stress.Supported by: Department of Defense (W81XWH-06-1-0317)7-LBPrimary Care Detection of CKD in Adults with Type-2 Diabetes inthe Awareness, Detection, and Drug Therapy in Type-2 Diabetesand Chronic Kidney Disease (ADD-CKD) StudyLYNDA A. SZCZECH, REBECCA C. STEWART, HSU-LIN SU, RICHARD J. DELOS-KEY, JOSEPH A. VASSALOTTI, ADD-CKD STUDY INVESTIGATORS, New York, NY,Princeton, NJApproximately 10–15% of the US population has chronic kidney disease(CKD). Diabetes is the leading cause of CKD. Early detection will encourageclinicians and patients to address factors that can improve outcomes.ADD-CKD was a US, multicenter, observational study that assessedthe prevalence of CKD in adult patients with type-2 diabetes (T2DM) andassessed and characterized the proportion of patients with detected andundiagnosed CKD in the primary care setting using the following: a cliniciansurvey; a patient physical exam and medical history; a single patient blooddraw for eGFR and glycosolated hemoglobin (HbA1c); a urine dipstick forprotein; an albumin-creatinine ratio; two patient quality of life questionnaires;and a 15-month patient medical record review. The study consisted of 9339adult patients with T2DM and 466 investigator sites. Of the 9339 enrolled,9307 could be assessed using tests for urine protein and serum creatinine toestablish the presence of CKD and to assess the sensitivity of the clinician inidentifying the presence of CKD.Of the 9307 patients, 5036 (54.1%) had Stage 1-5 CKD based on eGFR andalbuminuria; however, only 607 (12.1%) of those patients were identified ashaving CKD. Clinicians were more successful in diagnosing patients withStage 3-5 CKD than Stages 1 and 2. Of the 445 clinicians who enrolled atleast 10 patients, 19 (4.3%) had a ≥50% likelihood of identifying patients withCKD, 217 (48.8%) had a likelihood of