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Erschienen in:
01.06.2008 | Article
Long-term prevention of diabetic nephropathy: an audit
Erschienen in: Diabetologia | Ausgabe 6/2008
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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.