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Remission of nephrotic-range albuminuria reduces risk of end-stage renal disease and improves survival in type 2 diabetic patients
- Source :
- Diabetologia. 48(11)
- Publication Year :
- 2005
-
Abstract
- We evaluated the impact of remission of nephrotic-range albuminuria (2500 mg/24 h) (NRA) on end-stage renal disease (ESRD) and mortality in type 2 diabetic patients with nephropathy.This was a follow-up observational study involving all 79 patients (35%; 62 men, 17 women) with NRA from a cohort of type 2 diabetic patients with nephropathy that was followed for at least 3 years at the Steno Diabetes Center (n=227). Patients were followed from the onset of NRA until death or January 2005. The mean age (+/-SD) was 60+/-8 years and known diabetes duration was 14+/-7 years. Remission of NRA was defined as sustained albuminuria600 mg/24 h for at least 1 year.The duration of follow-up after onset of NRA was 6.5 years (range 2-20 years). Remission was induced in 20 (25%) of the patients, all treated with ACE inhibitors or angiotensin-II receptor blockers. Remission lasted 4.1 years (range 1-10 years) and only three patients relapsed. At the end of follow-up, only 30% (two ESRD and four deaths) of the 20 patients with remission had reached the composite endpoint of ESRD or death, in contrast to 66% (16 ESRD and 23 deaths) of the 59 patients without remission (p0.01). Cox regression analysis revealed that remission was associated with a risk reduction of 67% (95% CI 10-87) for reaching the composite endpoint of ESRD or death and of 69% (95% CI 21-88%) for death alone. Male sex, greater age and systolic blood pressure at onset of NRA were also independently associated with an increased risk of ESRD and death.Aggressive antihypertensive treatment can lead to long-term remission of NRA in a sizeable proportion of patients with type 2 diabetes. Such remission is associated with a slower progression of nephropathy and substantially improved survival.
- Subjects :
- Male
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
Urology
Angiotensin-Converting Enzyme Inhibitors
Type 2 diabetes
urologic and male genital diseases
End stage renal disease
Nephropathy
Diabetic nephropathy
Cohort Studies
Diabetic Neuropathies
Risk Factors
Diabetes mellitus
Internal Medicine
medicine
Albuminuria
Humans
Survival rate
Aged
business.industry
Incidence
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
Surgery
Survival Rate
Diabetes Mellitus, Type 2
Kidney Failure, Chronic
Female
medicine.symptom
business
Angiotensin II Type 1 Receptor Blockers
Kidney disease
Follow-Up Studies
Subjects
Details
- ISSN :
- 0012186X
- Volume :
- 48
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Diabetologia
- Accession number :
- edsair.doi.dedup.....dfc57dbb7f40722d76dd0ec3d783fa9b