Renal Disease Progresses in Slowly Type 2 Diabetics

"In patients with type 2 diabetes with overt nephropathy, the risk for progressive renal failure is high," Dr. Johannes F. E. Mann, of Schwabing General Hospital, Munchen, German, and colleagues write. "The risk is less well established for those with type 2 diabetes and microalbuminuria or normalbuminuria."

The researchers examined changes in serum creatinine levels in 3577 diabetic patients at high cardiovascular risk with microalbuminuria or normalbuminuria. They conducted a retrospective analysis of serum creatinine levels at baseline and every year thereafter in the Microalbuminuria and Renal Outcomes in the Heart Outcomes and Prevention Evaluation study comparing the effects of ramipril and placebo during 4.5 years. Included were 1139 patients with microalbuminuria and 333 with normalbuminuria.

No significant increases in serum creatinine levels were observed during the study when all diabetic subjects were considered or for subgroups with microalbuminuria and/or renal insufficiency at baseline. There were no differences between patients treated with ramipril and those who received placebo.

Of 3238 people, 474 newly developed a serum creatinine level of 1.4 mg/dL or greater, including 243 placebo-treated patients and 231 ramipril-treated patients, a difference between the groups that was not statistically significant. Of the 333 patients with baseline renal insufficiency, 8 saw their serum creatinine levels double or developed end-stage renal disease.

"On the basis of reaching threshold levels of renal function, progression rates are clinically meaningful, especially considering population life expectancy," the authors conclude. Am J Kidney Dis 2003;42:936-942.

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