alexa Long-term prevention of diabetic nephropathy: an audit.


Journal of Clinical Toxicology

Author(s): Schjoedt KJ, Hansen HP, Tarnow L, Rossing P, Parving HH, Schjoedt KJ, Hansen HP, Tarnow L, Rossing P, Parving HH, Schjoedt KJ, Hansen HP, Tarnow L, Rossing P, Parving HH, Schjoedt KJ, Hansen HP, Tarnow L, Rossing P, Parving HH

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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. This article was published in Diabetologia and referenced in Journal of Clinical Toxicology

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