Multifactorial intervention has a significant effect on diabetic kidney disease in patients with type 2 diabetes
| Autor: | Takayoshi Sasako, Kana Miyake, Mitsuhiko Noda, Yasuo Ohashi, Yukiko Okazaki, Masaomi Nangaku, Takashi Kadowaki, Kohjiro Ueki |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.medical_treatment Population 030232 urology & nephrology Renal function Type 2 diabetes 03 medical and health sciences 0302 clinical medicine Japan Internal medicine Diabetes mellitus medicine Albuminuria Humans Diabetic Nephropathies education education.field_of_study business.industry medicine.disease 030104 developmental biology Blood pressure Diabetes Mellitus Type 2 Nephrology Microalbuminuria Hemodialysis medicine.symptom business Glomerular Filtration Rate |
| Zdroj: | Kidney International. 99:256-266 |
| ISSN: | 0085-2538 |
| DOI: | 10.1016/j.kint.2020.08.012 |
| Popis: | To evaluate the effect of multifactorial intervention on the onset and progression of diabetic kidney disease in the patients with type 2 diabetes, we analyzed the effects of intensified multifactorial intervention by step-wise intensification of medications and life-style modifications (intensive therapy treatment targets; HbA1c under 6.2%, blood pressure under 120/75 mmHg, low-density lipoprotein cholesterol under 80 mg/dL) comparing with the guideline-based standard care (conventional therapy treatment targets: HbA1c under 6.9%, blood pressure under 130/80 mmHg, low-density lipoprotein cholesterol under 120 mg/dL) on diabetic kidney disease. A total of 2540 eligible patients in the Japan Diabetes Optimal Integrated Treatment for three major risk factors of cardiovascular diseases (J-DOIT3) cohort were randomly assigned to intensive therapy (1269) and conventional therapy (1271) and treated for a median of 8.5 years. The prespecified kidney outcome measure was a composite of progression from normoalbuminuria to microalbuminuria or progression from normoalbuminuria to macroalbuminuria or progression from microalbuminuria to macroalbuminuria, serum creatinine levels elevated by two-fold or more compared to baseline, or kidney failure. Primary analysis was carried out on the intention-to-treat population. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. A total of 438 kidney events occurred (181 in the intensive therapy group and 257 in the conventional therapy group). Intensive therapy was associated with a significant 32% reduction in kidney events compared to conventional therapy and was associated with a change in HbA1c at one year from study initiation. Thus, prespecified analysis shows that intensified multifactorial intervention significantly reduced the onset and progression of diabetic kidney disease compared to currently recommended care. |
| Databáze: | OpenAIRE |
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