Long-term prevention of diabetic nephropathy: an audit
| Autor: | Lise Tarnow, Henrik Post Hansen, H.-H. Parving, K. J. Schjoedt, Peter Rossing |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
medicine.medical_specialty Angiotensin receptor Endocrinology Diabetes and Metabolism Urology Angiotensin-Converting Enzyme Inhibitors Blood Pressure urologic and male genital diseases Diabetic nephropathy Internal medicine Internal Medicine Albuminuria Humans Medicine Diabetic Nephropathies Glycated Hemoglobin Medical Audit Type 1 diabetes Proteinuria business.industry Middle Aged medicine.disease Survival Analysis Angiotensin II female genital diseases and pregnancy complications Stroke Diabetes Mellitus Type 1 Endocrinology ACE inhibitor Disease Progression Kidney Failure Chronic Microalbuminuria medicine.symptom business Angiotensin II Type 1 Receptor Blockers Glomerular Filtration Rate medicine.drug Kidney disease |
| Zdroj: | Diabetologia. 51:956-961 |
| ISSN: | 1432-0428 0012-186X |
| Popis: | In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in microalbuminuric type 1 diabetic patients on progression of microalbuminuria and development of DN.All patients with type 1 diabetes and persistent microalbuminuria (30-300 mg/24 h) were identified (n=227) in 1995 at Steno Diabetes Center and followed for 11 years. Development of DN was defined as a UAER of300 mg/24 h in two of three consecutive urine samples.Age and duration of diabetes at baseline (mean+/-SD) were 46+/-15 and 28+/-13 years, respectively. During follow-up 14 patients emigrated and 58 (26%) died. Over the same period 79% were treated with an ACEI or ARB. There was a mean decline in UAER of 4%/year. Sixty-five patients (29%) progressed to overt DN, corresponding to 3.1%/year. However, 29 of them regressed to normo- or microalbuminuria on intensified antihypertensive treatment. Glycaemic control and blood pressure remained nearly unchanged.In our outpatient clinic, the implementation of RAAS-blocking treatment in type 1 diabetic patients with microalbuminuria successfully reduced long-term progression to overt DN to a rate similar to those previously reported in randomised, double-blind intervention trials of shorter duration using RAAS blockade. |
| Databáze: | OpenAIRE |
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