Progression of diabetic nephropathy

Hovind, Peter; Rossing, Peter; Tarnow, Lise; Smidt, Ulla M; Parving, Hans‐Henrik

doi:10.1046/j.1523-1755.2001.059002702.x

Cited by 291 publications

(209 citation statements)

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“…Variations in the rate of GFR decline in patients with type 2 diabetes with nephropathy have been described before in previous studies, ranging from 0.36 mL/min/1.73m 2 /year among the Japanese population11 to 4.7 mL/min/1.73m 2 /year among Brazilian subjects 19. Several other studies have also suggested an annual decline in GFR within this range 12131828. In our study, we showed an average of 3.3 mL/year drop in GFR and even greater among patients who reached ESRD (5.9 mL/year).…”

Section: Discussionsupporting

confidence: 57%

“…Several studies have identified age,1617 male gender,17 lower initial glomerular filtration rate (GFR),14–18 first–hospital-visit fasting plasma glucose18 and concomitant presence of retinopathy1920 as important risk factors for GFR decline. The proteinuria itself is a major risk factor for progression of DN 12–151920. Above all, these risk factors for progression of chronic kidney disease (CKD) in type 2 diabetes mellitus have not been fully elucidated.…”

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confidence: 99%

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Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:One out of five Saudi diabetics develops end-stage renal disease (ESRD). Factors associated with progressive loss of renal function have not been extensively studied and reported in our community. We sought to evaluate the pattern and progression in glomerular filtration rate (GFR) and investigate the potential risk factors associated with progression to diabetic nephropathy (DN) among Saudi patients.DESIGN AND SETTING:Hospital-based retrospective analysis of type 2 diabetic patients seen between January 1989 and January 2004 at Security Forces Hospital and King Saud University in Riyadh, Saudi Arabia.PATIENTS AND METHODS:DN was defined as persistent proteinuria assessed by urine dipstick [at least twice for at least two consecutive years and/or serum creatinine >130 μmol/L; and/or GFR <60 mL/min/1.73m2].RESULTS:Of 1952 files reviewed, 621 (31.8%) met the criteria for DN, and 294 (47%) were males. The mean (SD) age of the patients at baseline was 66.9 (11.4) years, and mean duration of diabetes was 15.4 (7.5) years. GFR deteriorated from a baseline value of 78.3 (30.3) mL/min/1.73m2 to 45.1 (24.1) mL/min/1.73m2 at the last visit, with a mean rate of decline in GFR of 3.3 mL/min/year. Progression of nephropathy was observed in 455 (73.3%) patients, with 250 (40.3%) patients doubling their first–hospital-visit serum creatinine level in a mean of 10.0 (6.0) years. At the end of the study, 16.5% of the cohort developed ESRD and were dialyzed. GFR >90 mL/min/1.73m2 at the first hospital visit; duration of diabetes >10 years; persistent proteinuria; systolic blood pressure >130 mm Hg; and presence of retinopathy were significant markers associated with progression of nephropathy.CONCLUSION:Diabetic nephropathy tends to be progressive among Saudis, with GFR deteriorating at a rate of 3.3 mL/year and with a doubling of serum creatinine level in 40.3% of patients in 9.9 years.

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Section: Discussionsupporting

confidence: 57%

mentioning

confidence: 99%

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Al-Wakeel

Isnani

Alsuwaida

et al. 2011

Annals of Saudi Medicine

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“…Two decades ago, it was demonstrated that antihypertensive treatment could delay the development of end-stage renal failure by reducing the rate of decline of the GFR [21,22], a finding that has subsequently been confirmed in randomised controlled trials (see below). Observational studies indicate a decline in the GFR of 3.7 ml min −1 year −1 in patients on antihypertensive therapy [23]. Poor glucose control and hypercholesterolaemia have also been associated with a more rapid deterioration of kidney function in observational, but not interventional, studies [23,24].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

“…Observational studies indicate a decline in the GFR of 3.7 ml min −1 year −1 in patients on antihypertensive therapy [23]. Poor glucose control and hypercholesterolaemia have also been associated with a more rapid deterioration of kidney function in observational, but not interventional, studies [23,24].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Rossing

2005

Diabetologia

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Diabetic microvascular complications in the kidney and the eye are a major burden for diabetic patients due to increased morbidity and mortality. Furthermore, diabetic nephropathy is the leading cause of end-stage renal disease and diabetic retinopathy is the leading cause of blindness in younger patients, representing a major public health concern. During the past two decades beneficial effects of, in particular, aggressive antihypertensive control and strict glycaemic control have been demonstrated in randomised controlled clinical trials. Technological improvements in diabetes care have made good metabolic control easier to achieve. Has this led to an improved prognosis? In observational studies from dedicated centres, a decrease from 47 to 13% has been reported in the incidence of proliferative diabetic retinopathy after 20-25 years of diabetes, and the incidence of overt diabetic nephropathy after 20 years has decreased from 28 to 5.8%. Even functional and morphological remission of diabetic nephropathy has been reported. Despite this, recent population-based studies have failed to demonstrate a decrease in the incidence of blindness caused by diabetes, and the incidence of end-stage renal disease has progressively increased. This may, in part, be the result of a combination of increasing numbers of diabetic patients and a lag phase between improvement in management and a decline in end-stage complications. It is of concern, however, that the results from specialised centres may not apply to routine diabetes care. It is, therefore, mandatory that the beneficial effects of pharmacological and non-pharmacological interventions demonstrated in clinical trials and recommended by treatment guidelines are translated into clinical practice to ensure a widespread improvement in prognosis.

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“…The renoprotective role of ACEI, beyond what can be attributed to BP reduction, has been shown in only 2 of 5 studies that compared these drugs to either CT or to CCB (25)(26)(27)(28)(29) in type 1 diabetic patients with overt nephropathy. In type 2 diabetic patients who also have overt nephropathy, 4 of 5 small trials that evaluated the effects of various classes of drugs failed to demonstrate that ACEI play any specific renoprotective role (20,30 -33).…”

Section: Renal Protectionmentioning

confidence: 99%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Hypertension, impaired renal function, and proteinuria are commonly associated to the presence of diabetes. They play a major role in the development of cardiovascular and renal damage. Effective antihypertensive treatment reduces the progression of diabetic nephropathy and improves cardiovascular prognosis. Accordingly, tight BP control (Ͻ130/80 mmHg) is currently recommended in diabetic patients. Achieving BP targets represents the most important determinant of cardiovascular and renal protection. However, it has been suggested that specific classes of antihypertensive drugs may exert additional organ protection beyond their BP control. The pharmacologic blockade of the renin-angiotensin-aldosterone system has been shown to convey greater renal and cardiovascular protection compared with other classes of drugs. In particular, studies focusing on renal end point suggest that angiotensin-converting enzyme inhibitors (ACEI) are the firstchoice drugs in type 1 diabetes. Both ACEI and angiotensin II receptor blockers prevent the progression from microalbuminuria to clinical proteinuria in type 2 diabetes, but angiotensin blockers provide better renoprotection in patients with overt nephropathy. Regarding cardiovascular protection, several studies (but not all) have shown that ACEI exert a protective effect on diabetic patients. Recently, interesting results in favor of angiotensin receptor blockers have been reported in the IDNT, RENAAL, and LIFE studies. It should be noted that to achieve maximal renal and cardiovascular protection, most diabetic patients require integrated therapeutic intervention, including not only several antihypertensive drugs, but statins and antiplatelet therapy as well.Diabetes, hypertension, impaired renal function, and proteinuria are commonly associated conditions that act as a guilty company. They are, in fact, responsible for an increase in the risk of development and/or progression of cardiovascular disease, nephropathy, and retinopathy.Arterial BP plays a very important role in the development of renal damage and presents a complex relationship with diabetic nephropathy, with nephropathy raising BP, and with BP accelerating the course of nephropathy (1). Furthermore, as shown by epidemiologic studies, hypertension is responsible for increased cardiovascular morbidity and mortality associated with diabetes mellitus (1). Effective antihypertensive treatment reduces the risk of development and progression of nephropathy and, as is especially evident with angiotensinconverting enzyme (ACE) inhibitors (ACEI) and angiotensin receptor blockers (ARB), it lowers cardiovascular morbidity and mortality (2,3). Accordingly, current consensus groups have recommended tight BP control (Ͻ130/80 mmHg) in diabetic patients (2,4 -7).Proteinuria is considered a predictor of renal disease progression. Proteinuria acts on tubular cells by inducing inflammation and consequently interstitial fibrosis. In addition, proteinuria favors dyslipidemia, which aggravates renal damage and increases cardiov...

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Progression of diabetic nephropathy

Abstract: The prognosis of diabetic nephropathy has improved during the past decades, predominantly because of effective antihypertensive treatment. Genuine normotensive patients have a slow progression of nephropathy. Several modifiable variables have been identified as progression promoters.

Cited by 291 publications

References 50 publications

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

Factors affecting the progression of diabetic nephropathy and its complications: A single-center experience in Saudi Arabia

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Optimizing Therapy in the Diabetic Patient with Renal Disease

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