Changes in albuminuria and renal outcome in patients with type 2 diabetes and hypertension

Viazzi, Francesca; Ceriello, Antonio; Fioretto, Paola; Giorda, Carlo; Guida, Pietro; Russo, Giuseppina; Greco, Eulalia; Cosmo, Salvatore De; Pontremoli, Roberto

doi:10.1097/hjh.0000000000001749

Cited by 10 publications

(9 citation statements)

References 32 publications

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“…In general, the results of such studies support those of the major outcomes trials, even though in most countries, SGLT2 inhibitors are not prescribed in patients with eGFR < 60 mL/min/1.73 m 2 , limiting the possibility to extend these observations to a T2D population at higher renal risk. In people with T2D and hypertension, changes in albuminuria occurred in parallel with changes in adverse renal outcomes in an observational study [ 104 ], and other studies have shown that UACR is a strong predictor of albuminuria progression in people with T2D [ 105 ]. Baseline prevalence of microalbuminuria and macroalbuminuria in EMPA-REG OUTCOME (28.7% and 11%, respectively) [ 30 ] and the CANVAS program (23% and 8%, respectively) [ 106 ] were also similar to that reported in real-world studies [ 105 , 107 ].…”

Section: Renoprotective Effects Of Sglt2 Inhibitors According To Basementioning

confidence: 99%

Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk

Giorgino

Vora

Fenici

et al. 2020

Cardiovasc Diabetol

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Approximately half of all patients with type 2 diabetes (T2D) develop a certain degree of renal impairment. In many of them, chronic kidney disease (CKD) progresses over time, eventually leading to end-stage kidney disease (ESKD) requiring dialysis and conveying a substantially increased risk of cardiovascular morbidity and mortality. Even with widespread use of renin–angiotensin system blockers and tight glycemic control, a substantial residual risk of nephropathy progression remains. Recent cardiovascular outcomes trials investigating sodium–glucose cotransporter 2 (SGLT2) inhibitors have suggested that these therapies have renoprotective effects distinct from their glucose-lowering action, including the potential to reduce the rates of ESKD and acute kidney injury. Although patients in most cardiovascular outcomes trials had higher prevalence of existing cardiovascular disease compared with those normally seen in clinical practice, the proportion of patients with renal impairment was similar to that observed in a real-world context. Patient cardiovascular risk profiles did not relevantly impact the renoprotective benefits observed in these studies. Benefits were observed in patients across a spectrum of renal risk, but were evident also in those without renal damage, suggesting a role for SGLT2 inhibition in the prevention of CKD in people with T2D. In addition, recent studies such as CREDENCE and DAPA-CKD offer a greater insight into the renoprotective effects of SGLT2 inhibitors in patients with moderate-to-severe CKD. This review outlines the evidence that SGLT2 inhibitors may prevent the development of CKD and prevent and delay the worsening of CKD in people with T2D at different levels of renal risk.

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Section: Renoprotective Effects Of Sglt2 Inhibitors According To Basementioning

confidence: 99%

Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk

Giorgino

Vora

Fenici

et al. 2020

Cardiovasc Diabetol

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“…Albuminuria is a known marker of renal damage and has been shown to have a strong cardiovascular and renal predictive power. Furthermore, modifications of urinary albumin excretion under pharmacological treatment might impact CV and renal prognosis independent of blood pressure reduction [ 9 – 11 ]. In the classical, five-stage course of diabetic nephropathy, mostly derived from studies conducted in patients with type 1 diabetes, microalbuminuria has traditionally been taken to represent the first sign of renal involvement [ 12 ] (Fig.…”

Section: Antihypertensive Treatment and Renal Protection In Type 2 DImentioning

confidence: 99%

Blood pressure reduction and RAAS inhibition in diabetic kidney disease: therapeutic potentials and limitations

et al. 2020

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Diabetic kidney disease (DKD) affects approximately one-third of patients with diabetes and taking into consideration the high cardiovascular risk burden associated to this condition a multifactorial therapeutic approach is traditionally recommended, in which glucose and blood pressure control play a central role. The inhibition of renin–angiotensin–aldosterone RAAS system represent traditionally the cornerstone of DKD. Clinical outcome trials have demonstrated clinical significant benefit in slowing nephropathy progression mainly in the presence of albuminuria. Thus, international guidelines mandate their use in such patients. Given the central role of RAAS activity in the pathogenesis and progression of renal and cardiovascular damage, a more profound inhibition of the system by the use of multiple agents has been proposed in the past, especially in the presence of proteinuria, however clinical trials have failed to confirm the usefulness of this therapeutic approach. Furthermore, whether strict blood pressure control and pharmacologic RAAS inhibition entails a favorable renal outcome in non-albuminuric patients is at present unclear. This aspect is becoming an important issue in the management of DKD since nonalbuminuric DKD is currently the prevailing presenting phenotype. For these reasons it would be advisable that blood pressure management should be tailored in each subject on the basis of the renal phenotype as well as related comorbidities. This article reviews the current literature and discusses potentials and limitation of targeting the RAAS in order to provide the greatest renal protection in DKD.

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“…Another recent European population-based study showed that BP control was not achieved among most hypertensive patients with diabetes mellitus and the mean BP was 142 /81 mm Hg. 26 Studies have shown that any decrease in albuminuria was strongly related to decreased risk for CV events and all-cause mortality as well as improved renal outcomes . 10–12 Over the study period, the prevalence of albuminuria decreased by nearly 20% (from 39.1% to 31.3%, P = .02).…”

Section: Discussionmentioning

confidence: 99%

Patterns of Antihypertensive Drug Utilization among US Adults with Diabetes and Comorbid Hypertension: The National Health and Nutrition Examination Survey 1999-2014

Farzadeh

Chang

et al. 2019

Clin Med Insights Cardiol

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Background: Diabetes and hypertension are the 2 leading risk factors for suboptimal cardiovascular and renal outcomes. These 2 conditions often coexist and can benefit from antihypertensive therapy, which may lead to blood pressure control and reduced risk for nephropathy (as evidenced by albuminuria). Objective: To quantify the trends of antihypertensive drug use and to assess the impact of antihypertensive treatment on the prevalence of blood pressure control and albuminuria, among US adults with coexisting diabetes and hypertension. Methods: In this serial cross-sectional study, we analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 3586). We determine the prevalence of antihypertensive use, drug classes used, and their association with blood pressure control and albuminuria. Results: During the study period, the study population experienced substantial increase in antihypertensive treatment (from 84.6% in 1999-2002 to 90.1% in 2011-2014, P trend < .01) and blood pressure control (from 37.1% to 46.9%, P trend < .01) and decrease in albuminuria (from 39.1% to 31.3%, P trend = .02). These trends were particularly pronounced in the subgroups using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers. In multivariate analysis, Blacks, Hispanics, and males were found more likely to have albuminuria than their respective counterparts. Achieving blood pressure control (odds ratio = 0.40, 95% confidence interval [CI]: 0.32-0.49) was associated with lower rates of albuminuria. Conclusion And Relevance: Despite continued improvement in antihypertensive therapy, the burden of uncontrolled blood pressure and albuminuria remains substantial among US adults with diabetes and hypertension. Tailoring pharmacotherapy based on patient characteristics and comorbidities is needed to further improve these outcomes.

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Changes in albuminuria and renal outcome in patients with type 2 diabetes and hypertension

Abstract: In patients with hypertension and T2D under real-life clinical conditions, changes in albuminuria parallel changes of renal risk. Albuminuria status could be a guide to optimize therapeutic strategy.

Cited by 10 publications

References 32 publications

Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk

Renoprotection with SGLT2 inhibitors in type 2 diabetes over a spectrum of cardiovascular and renal risk

Blood pressure reduction and RAAS inhibition in diabetic kidney disease: therapeutic potentials and limitations

Patterns of Antihypertensive Drug Utilization among US Adults with Diabetes and Comorbid Hypertension: The National Health and Nutrition Examination Survey 1999-2014

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