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Item
#10
Decline
In Renal Function After Dialysis Can Be Halved
End-state
renal failure can be reduced by 50%
The
rate of decline in renal function in patients starting dialysis
can be almost halved in clinical practice. This is comparable to
the major reductions achieved by interventions, especially blood
pressure control, used in clinical trials.
Noting that diabetic nephropathy is the most common cause of
end-stage renal failure in patients beginning dialysis,
specialists at Glasgow Royal Infirmary, Glasgow, Scotland, studied
demographic and laboratory data on 170 consecutive patients
referred to a combined diabetic-renal clinic over the course of 10
years.
Median serum creatinine at referral was 170 µmol/l and exceeded
350 µmol/l in 26 percent of patients. Mean blood pressure was
159/85 mmHg. Guidelines by the Scottish Intercollegiate Guidelines
Network recommending more active intervention and earlier referral
had no impact on referral blood pressure and creatinine.
There were significant improvements in blood pressure,
albuminuria, HbA1c and serum cholesterol in 125
patients after at least one-year follow-up. In 63 patients
followed up for three years (median creatinine 120 µmol/l), the
median rate of decline in renal function slowed significantly,
from 0.52 ml/min/month in the first year to 0.27 ml/min/month in
the third year, thus nearly doubling the time to end-stage renal
failure.
The specialists observed that reducing the rate of progression to
less than 0.25 ml/min/month in 70 percent of patients with
diabetic nephropathy presenting with serum creatinine below 150 µmol/l
would be "a challenging but achievable standard" for
audit.
Quarterly
Journal of Medicine 2002;95:41-49
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Did
you know?
Without
early diagnosis and appropriate treatment, children with type 2
diabetes may begin to have diabetes-related complications while in
their 20’s and 30’s.
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