Long-term prevention of diabetic nephropathy: an audit

K J Schjoedt, H P Hansen, L Tarnow, P Rossing, H-H Parving

    19 Citationer (Scopus)

    Abstract

    AIMS/HYPOTHESIS: 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.

    METHODS: 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 of >300 mg/24 h in two of three consecutive urine samples.

    RESULTS: 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.

    CONCLUSIONS/INTERPRETATION: 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.

    OriginalsprogEngelsk
    TidsskriftDiabetologia
    Vol/bind51
    Udgave nummer6
    Sider (fra-til)956-61
    Antal sider6
    ISSN0012-186X
    DOI
    StatusUdgivet - jun. 2008

    Fingeraftryk

    Dyk ned i forskningsemnerne om 'Long-term prevention of diabetic nephropathy: an audit'. Sammen danner de et unikt fingeraftryk.

    Citationsformater