Abstract | BACKGROUND:
Diabetic nephropathy is a major cause of renal failure. The decline in glomerular filtration rate (GFR) is highly variable, ranging from 2 to 20, with a median of 12 mL/min/year. The risk factors of losing filtration power (progression promoters) have not been clearly identified. Furthermore, information on optimal arterial blood pressure, glycemic control, and cholesterol levels are lacking. METHODS: RESULTS: Mean arterial blood pressure was 102 +/- 0.4 (SE) mm Hg. The average decline in GFR was 4.0 +/- 0.2 mL/min/year and even lower (1.9 +/- 0.5 mL/min/year) in the 30 persistently normotensive patients, none of whom had ever received antihypertensive treatment (P < 0.01). A multiple linear regression analysis revealed a significant positive correlation between the decline in GFR and mean arterial blood pressure, albuminuria, glycosylated hemoglobin A(1c), and serum cholesterol during follow-up (R(adj)(2) = 0.29, P < or = 0.001). No threshold level for blood pressure, glycosylated hemoglobin A(1c), or serum cholesterol was demonstrated. A two-hit model with mean arterial blood pressure and glycosylated hemoglobin A(1c) below and above the median values (102 mm Hg and 9.2%, respectively) revealed a rate of decline in GFR of only 1.5 mL/min/year in the lowest stratum compared with 6.1 mL/min/year in the highest stratum (P < 0.001). CONCLUSIONS: The prognosis of diabetic nephropathy has improved during the past decades, predominantly because of effective antihypertensive treatment. Genuine normotensive patients have a slow progression of nephropathy. Several modifiable variables have been identified as progression promoters.
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Authors | P Hovind, P Rossing, L Tarnow, U M Smidt, H H Parving |
Journal | Kidney international
(Kidney Int)
Vol. 59
Issue 2
Pg. 702-9
(Feb 2001)
ISSN: 0085-2538 [Print] United States |
PMID | 11168952
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Glycated Hemoglobin A
- Cholesterol
- Edetic Acid
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Topics |
- Adult
- Albuminuria
(etiology)
- Blood Pressure
- Cholesterol
(blood)
- Diabetic Nephropathies
(physiopathology)
- Disease Progression
- Edetic Acid
(blood)
- Female
- Glomerular Filtration Rate
- Glycated Hemoglobin
(analysis)
- Humans
- Male
- Middle Aged
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