Ongoing treatment with renin-angiotensin-aldosterone-blocking agents does not predict normoalbuminuric renal impairment in a general type 2 diabetes population
Ongoing treatment with renin-angiotensin-aldosterone-blocking agents does not predict normoalbuminuric renal impairment in a general type 2 diabetes population
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DOI：
10.1016/j.jdiacomp.2012.10.010
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发表时间：
2013-05-01
影响因子：
3
通讯作者：
Svensson, Maria K.
中科院分区：
文献类型：
--
作者：
Afghahi, Hanri;Miftaraj, Mervete;Svensson, Maria K.
目的：研究普通2型糖尿病（T2 D）人群中与正常白蛋白尿肾损害（RI）相关的患病率和临床特征。（56%男性，年龄683 +/- 11.6岁，BMI 29.6 +/- 5.3 kg/m2，糖尿病病程8.5 +/- 7.1年;平均值+/- SD），2009年向瑞典国家糖尿病登记中心（NDR）报告肾功能（血清肌酐）。RI被定义为估计肾小球滤过率（eGFR）20 μ g/min。我们将NDR与瑞典处方药登记处，瑞典死因和医院出院登记处，以评估正在进行的药物治疗和临床outcomes.Results：17%的患者有RI，62%的这些患者是normoalbuminuria。与蛋白尿RI患者相比，这组患者代谢控制更好，BMI更低，收缩压更低，且更多为女性，不吸烟者，很少有心血管疾病史。28%的正常白蛋白尿RI患者未接受任何RAAS阻断剂治疗。视网膜病变是最常见的RI和蛋白尿（31%）的患者。结论：大多数2型糖尿病和RI的患者是normoalbuminuria，尽管事实上，这些患者中有25%没有正在进行的治疗RAAS阻断剂。因此，在许多2型糖尿病患者中，RI可能是由糖尿病微血管疾病和持续RAAS阻断以外的其他因素引起的。(C)2013 Elsevier Inc. All rights reserved.
Aim: To examine the prevalence and the clinical characteristics associated with normoalbuminuric renal impairment (RI) in a general type 2 diabetes (T2D) population.Methods: We included 94 446 patients with T2D (56% men, age 683 +/- 11.6 years, BMI 29.6 +/- 5.3 kg/m(2), diabetes duration 8.5 +/- 7.1 years; means +/- SD) with renal function (serum creatinine) reported to the Swedish National Diabetes Register (NDR) in 2009. RI was defined as estimated glomerular filtration (eGFR)20 mu g/min. We linked the NDR to the Swedish Prescribed Drug Register, and the Swedish Cause of Death and the Hospital Discharge Register to evaluate ongoing medication and clinical outcomes.Results: 17% of the patients had RI, and 62% of these patients were normoalbuminuric. This group of patients had better metabolic control, lower BMI, lower systolic blood pressure and were more often women, nonsmokers and more seldom had a history of cardiovascular disease as compared with patients with albuminuric RI. 28% of the patients with normoalbuminuric RI had no ongoing treatment with any RAAS-blocking agent. Retinopathy was most common in patients with RI and albuminuria (31%).Conclusions: The majority of patients with type 2 diabetes and RI were normoalbuminuric despite the fact that 25% of these patients had no ongoing treatment with RAAS-blocking agents. Thus, RI in many patients with type 2 diabetes is likely to be caused by other factors than diabetic microvascular disease and ongoing RAAS-blockade. (C) 2013 Elsevier Inc. All rights reserved.