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Title: Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database.
Austin Authors: Packham, David K;Alves, Tahira P;Dwyer, Jamie P;Atkins, Robert;de Zeeuw, Dick;Cooper, Mark E;Shahinfar, Shahnaz;Lewis, Julia B;Lambers Heerspink, Hiddo J
Affiliation: Melbourne Renal Research Group, Royal Melbourne Hospital, Nephrology and Austin Hospital, Nephrology, Melbourne, Australia
Issue Date: 3-Nov-2011
Publication information: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation 2011; 59(1): 75-83
Abstract: Previous studies have shown that patients with chronic kidney disease, including those with diabetic nephropathy, are more likely to die of cardiovascular disease than reach end-stage renal disease (ESRD). This analysis was conducted to determine whether ESRD is a more common outcome than cardiovascular death in patients with type 2 diabetic nephropathy, significant proteinuria, and decreased kidney function who were selected for participation in a clinical trial.Retrospective analysis of the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database derived from 2 prospective randomized controlled clinical trials (IDNT [Irbesartan Diabetic Nephropathy Trial] and RENAAL [Reduction of Endpoints in Non-Insulin-dependent Diabetes With the Angiotensin II Antagonist Losartan]).3,228 adult patients with type 2 diabetic nephropathy from IDNT and RENAAL were combined to establish the DIAMETRIC database. This is the largest global source of clinical information for patients with type 2 diabetic nephropathy who have decreased kidney function and significant proteinuria.Angiotensin receptor blocker versus non-angiotensin receptor blocker therapy to slow the progression of type 2 diabetic nephropathy (in the prospective trials).Incidence rates of ESRD, cardiovascular death, and all-cause mortality.Mean follow-up was 2.8 years; 19.5% of patients developed ESRD, approximately 2.5 times the incidence of cardiovascular death and 1.5 times the incidence of all-cause mortality. ESRD was more common than cardiovascular death in all subgroups analyzed with the exception of participants with low levels of albuminuria (albumin excretion <1.0 g/g) and well-preserved levels of kidney function (estimated glomerular filtration rate >45 mL/min/1.73 m(2)) at baseline.All participants were included in a prospective clinical trial.Patients with type 2 diabetic nephropathy, characterized by decreased kidney function and significant proteinuria, are more likely to reach ESRD than die during 3 years' mean follow-up. Given the rapidly increasing number of cases of type 2 diabetes worldwide, this has implications for predicting future renal replacement therapy requirements.
Gov't Doc #: 22051245
DOI: 10.1053/j.ajkd.2011.09.017
Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation
Type: Journal Article
Subjects: Cardiovascular Diseases.etiology.mortality
Databases, Factual
Diabetes Mellitus, Type 2.complications
Diabetic Nephropathies.complications
Kidney Failure, Chronic.epidemiology.etiology
Middle Aged
Retrospective Studies
Appears in Collections:Journal articles

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