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Remission of nephrotic-range albuminuria reduces risk of end-stage renal disease and improves survival in type 2 diabetic patients

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... Full description

Journal Title: Diabetologia 2005, Vol.48 (11), p.2241-2247
Main Author: ROSSING, K
Other Authors: CHRISTENSEN, P. K , HOVIND, P , PARVING, H.-H
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin: Springer
ID: ISSN: 0012-186X
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title: Remission of nephrotic-range albuminuria reduces risk of end-stage renal disease and improves survival in type 2 diabetic patients
format: Article
creator:
  • ROSSING, K
  • CHRISTENSEN, P. K
  • HOVIND, P
  • PARVING, H.-H
subjects:
  • Aged
  • Albuminuria - complications
  • Albuminuria - epidemiology
  • Angiotensin
  • Angiotensin II Type 1 Receptor Blockers - therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors - therapeutic use
  • Biological and medical sciences
  • Care and treatment
  • Chronic kidney failure
  • Cohort Studies
  • Development and progression
  • Diabetes Mellitus, Type 2 - complications
  • Diabetes Mellitus, Type 2 - drug therapy
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetes. Impaired glucose tolerance
  • Diabetic nephropathies
  • Diabetic Neuropathies - complications
  • Diabetic Neuropathies - drug therapy
  • Diabetic Neuropathies - epidemiology
  • Diabetics
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Failure, Chronic - epidemiology
  • Kidney Failure, Chronic - etiology
  • Kidney Failure, Chronic - mortality
  • Kidneys
  • Male
  • Medical sciences
  • Middle Aged
  • Mortality
  • Nephrology. Urinary tract diseases
  • Patient outcomes
  • Risk Factors
  • Survival Rate
  • Type 2 diabetes
  • Urinary system involvement in other diseases. Miscellaneous
ispartof: Diabetologia, 2005, Vol.48 (11), p.2241-2247
description: 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 albuminuria
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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titleRemission of nephrotic-range albuminuria reduces risk of end-stage renal disease and improves survival in type 2 diabetic patients
creatorROSSING, K ; CHRISTENSEN, P. K ; HOVIND, P ; PARVING, H.-H
creatorcontribROSSING, K ; CHRISTENSEN, P. K ; HOVIND, P ; PARVING, H.-H
descriptionWe 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 albuminuria <600 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 (p<0.01). 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.
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1EISSN: 1432-0428
2DOI: 10.1007/s00125-005-1937-6
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subjectAged ; Albuminuria - complications ; Albuminuria - epidemiology ; Angiotensin ; Angiotensin II Type 1 Receptor Blockers - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Biological and medical sciences ; Care and treatment ; Chronic kidney failure ; Cohort Studies ; Development and progression ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Diabetes. Impaired glucose tolerance ; Diabetic nephropathies ; Diabetic Neuropathies - complications ; Diabetic Neuropathies - drug therapy ; Diabetic Neuropathies - epidemiology ; Diabetics ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - mortality ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Mortality ; Nephrology. Urinary tract diseases ; Patient outcomes ; Risk Factors ; Survival Rate ; Type 2 diabetes ; Urinary system involvement in other diseases. Miscellaneous
ispartofDiabetologia, 2005, Vol.48 (11), p.2241-2247
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1CHRISTENSEN, P. K
2HOVIND, P
3PARVING, H.-H
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descriptionWe 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 albuminuria <600 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 (p<0.01). 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.
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0Aged
1Albuminuria - complications
2Albuminuria - epidemiology
3Angiotensin
4Angiotensin II Type 1 Receptor Blockers - therapeutic use
5Angiotensin-Converting Enzyme Inhibitors - therapeutic use
6Biological and medical sciences
7Care and treatment
8Chronic kidney failure
9Cohort Studies
10Development and progression
11Diabetes Mellitus, Type 2 - complications
12Diabetes Mellitus, Type 2 - drug therapy
13Diabetes Mellitus, Type 2 - mortality
14Diabetes. Impaired glucose tolerance
15Diabetic nephropathies
16Diabetic Neuropathies - complications
17Diabetic Neuropathies - drug therapy
18Diabetic Neuropathies - epidemiology
19Diabetics
20Endocrine pancreas. Apud cells (diseases)
21Endocrinopathies
22Etiopathogenesis. Screening. Investigations. Target tissue resistance
23Female
24Follow-Up Studies
25Humans
26Incidence
27Kidney Failure, Chronic - epidemiology
28Kidney Failure, Chronic - etiology
29Kidney Failure, Chronic - mortality
30Kidneys
31Male
32Medical sciences
33Middle Aged
34Mortality
35Nephrology. Urinary tract diseases
36Patient outcomes
37Risk Factors
38Survival Rate
39Type 2 diabetes
40Urinary system involvement in other diseases. Miscellaneous
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authorROSSING, K ; CHRISTENSEN, P. K ; HOVIND, P ; PARVING, H.-H
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1Albuminuria - complications
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4Angiotensin II Type 1 Receptor Blockers - therapeutic use
5Angiotensin-Converting Enzyme Inhibitors - therapeutic use
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32Medical sciences
33Middle Aged
34Mortality
35Nephrology. Urinary tract diseases
36Patient outcomes
37Risk Factors
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40Urinary system involvement in other diseases. Miscellaneous
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issue11
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abstractWe 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 albuminuria <600 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 (p<0.01). 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.
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