Issue 182 Item 11 Patients With Type 2 Diabetes With Microalbuminuria Or Normalb

Patients with type 2 diabetes who are at high risk for cardiovascular disease but without overt nephropathy exhibit a slow but significant course of renal insufficiency.

The incidence of type 2 diabetes coupled with renal failure is increasing steadily in developed countries. Although previous studies have demonstrated quick progression of renal insufficiency in cases of overt diabetic nephropathy, less evidence exists concerning the risk for renal insufficiency progression or development of end stage renal disease in diabetic patients with microalbuminuria or normalbuminuria.

Hypothesising that patients with type 2 diabetes at high risk for cardiovascular disease would also be at high risk for development and progression of renal insufficiency, Johannes F. E. Mann, MD, of Ludwig Maximilians University in Munchen, Germany, and colleagues studied serum creatinine level changes in diabetics at high cardiovascular risk with and without microalbuminuria.

The researchers performed a retrospective analysis of baseline and annual serum creatinine levels measured for participants in the Heart Outcomes and Prevention Evaluation study, which compared the effects of ramipril, an angiotensin converting enzyme (ACE) inhibitor used to prevent kidney failure due to high blood pressure and diabetes, with placebo.

A total of 3,577 diabetic patients participated in the study, including 1,139 participants with microalbuminuria and 333 participants with renal insufficiency, and received follow up over a period of 4.5 years.

Several cardiovascular risk factors were observed in participants with renal insufficiency, including male gender and a history of hypertension and atherosclerotic vascular disease. Additionally, antihypertensive drugs were also more frequently used.

Analysis showed that serum creatinine levels did not increase significantly during the study for the entire population, or for subgroups with baseline microalbuminuria and/or renal insufficiency.

However, slopes of serum creatinine showed a significant trend for increasing values over time. There were no differences between the placebo and ramipril-treated groups, and major renal endpoints such as doubling of serum-creatinine or end stage renal disease were rarely noted.

Despite the observation of stable renal excretory function based on mean serum-creatinine values observed, participants with renal insufficiency were less likely to survive than patients without renal insufficiency.

The data also indicated that use of ramipril was not associated with a tendency to develop acute renal failure or worsening of renal function.

The research was sponsored in part by grants from Aventis, Astra-Zeneca, NEGMA, Natural Source Vitamin E Producers Association, and King Pharmaceuticals. Am J Kidney Dis 2003 Nov;42:5:936-42

================================

Did YOU KNOW:
The likelihood of developing Type 2 diabetes rises as the pounds go on. Around 85 per cent of the world’s diabetics are Type 2, and 90 per cent of them are overweight. America and Britain have high rates but will be overtaken, if trends continue, by India and the Middle East within two decades.