Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)

Adler, Amanda I; Stevens, R J; Manley, S E; Bilous, Rudy; Cull, C A; Holman, Rury R.; Group, UKPDS

doi:10.1046/j.1523-1755.2003.00712.x

Cited by 1,557 publications

(1,141 citation statements)

References 49 publications

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“…3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Besides macrovascular complications, microangiopathy represents a major burden and seems more strongly linked to chronic hyperglycaemia than macroangiopathy, both in T1DM [57] andT2DM [6]. It has a major impact on the quality of life but also reduces life expectancy, especially when diabetic nephropathy is present [58]. All diabetic retinopathy end points (including proliferative retinopathy, macular edema, and vision-threatening retinopathy) increases with diabetes duration and poor glucose control (assessed by high HbA1c), although their prevalence is higher in people with T1DM compared with T2DM [59].…”

Section: B) Non-inferiority Trialsmentioning

confidence: 99%

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Scheen

Charbonnel

2014

Diabetes & Metabolism

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Type 2 diabetes mellitus is strongly associated with cardiovascular complications, especially coronary artery disease. Numerous epidemiological studies showed a close relationship between major cardiovascular events and glycaemia and several pathophysiological mechanisms have been described that explain how hyperglycaemia induces vascular damages. However, randomized controlled trials that investigated either an intensive glucose lowering strategy versus standard care or the addition of a new glucose-lowering agent versus a placebo largely failed to demonstrate any clinical benefits in terms of cardiovascular morbidity or mortality. This lack of evidence led some people to contest the clinical efficacy of lowering blood glucose in patients with type 2 diabetes, despite its positive effects on microvascular complications. In this article, we analyze the various reasons that may explain such discrepancies. There are still strong arguments in favour of targeting hyperglycaemia, but avoiding other counterproductive effects, such as hypoglycaemia and weight gain, and integrating the glucose-lowering approach within a global multirisk strategy to reduce the burden of cardiovascular disease in type 2 diabetes.

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Section: B) Non-inferiority Trialsmentioning

confidence: 99%

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Scheen

Charbonnel

2014

Diabetes & Metabolism

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“…W hen kidney function declines, death from cardiovascular disease (CVD) predominates over progression of chronic kidney disease (CKD) (1)(2)(3). Excess CVD risk even in early-stage CKD is not fully explained by traditional, Framingham-type CVD risk factors.…”

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confidence: 99%

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Tuttle

Short

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Coronary artery calcification (CAC) is common in advanced chronic kidney disease (CKD), yet its onset and time course are uncertain. The study objective was to assess longitudinal relationships among CAC, kidney function, and traditional and putative cardiovascular disease (CVD) risk factors.Design, setting, participants, & measurements: This is a prospective cohort analysis from the Spokane Heart Study, a long-term observational study of community-dwelling adults who were assessed every 2 yr for CAC (electron-beam computed tomography), CVD risk factors, and laboratory testing. Estimated GFR (eGFR) was determined by the reexpressed Modification of Diet in Renal Disease equation.Results: CAC was present in 28% (245 of 883) at baseline. After 6 yr, new-onset CAC developed in 33% (122 of 371); severity increased from a median CAC score of 38 to 152 in those with baseline CAC. Neither eGFR (101 ؎ 34 versus 104 ؎ 31 ml/min per 1.73 m 2 , respectively) nor serum phosphorus (3.25 ؎ 0.49 versus 3.29 ؎ 0.48 mg/dl, respectively) differed by CAC presence or absence at baseline; however, multivariate models (generalized estimating equations for incidence and prevalence) revealed that independent predictors of CAC over time were greater baseline CAC scores, higher serum phosphorus levels, lower eGFR levels, and traditional CVD risk factors. Each 1-mg/dl increase in phosphorus imparted odds ratios for CAC of 1.61 (incidence) and 1.54 (prevalence), risks comparable to traditional CVD risk factors.Conclusions: CAC becomes more frequent and severe over time. Higher levels of serum phosphorus and reduced kidney function independently predicted CAC.

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“…[16][17][18] This phenomenon is clearly observed in patients with type II DM, in which ¼ of the patients presents with renal compromise after ten years of disease. 19 Proteinuria was also associated with higher mortality rates, as published by other authors who demonstrated this is a risk factor that is not connected to cardiovascular mortality. 20,21 On the other hand, the relation between the use of statins and lower mortality rates, as well as the slower progression to renal function failure with the need for RRT, is controversial.…”

Section: Discussionmentioning

confidence: 54%

Associação entre fatores de risco clínicos e laboratoriais e progressão da doença renal crônica pré-dialítica

Pereira¹,

Carminatti²,

Fernandes³

et al. 2012

J. Bras. Nefrol.

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ResumoIntrodução: A doença renal crônica (DRC) é muito prevalente e representa um importante problema de saúde pública. O maior conhecimento dos fatores de risco relacionados à progressão da DRC permite adotar estratégias terapêuticas que podem alterar o curso natural da doença. Objetivo: Avaliar o impacto de variáveis clínicas e laboratoriais à admissão nos desfechos de óbito e início de terapia renal substitutiva (TRS). Métodos: Estudo de coorte retrospectiva, composta de 211 pacientes adultos com DRC nos estágios 3-5 tratados, acompanhados por 56,6 ± 34,5 meses. Resultados: A idade média dos pacientes foi de 65,4 ± 15,1 anos, sendo 63,5% com > 60 anos. As principais etiologias de DRC foram nefroesclerose hipertensiva (29%) e doença renal diabética (DRD) (17%). A maioria dos pacientes encontravase no estágio 4 da DRC (47,3%). A perda média anual de taxa de filtração glomerular (TFG) foi 0,6 ± 2,5 mL/min/1,73 m 2 (mediana 0,7 mL/min/1,73 m 2 ). Após os ajustes para as variáveis demográficas, clínicas e laboratoriais, concluiu-se que apresentar DRD [risco relativo (RR) 4,4; intervalo de confiança (IC) 95%, 1,47-13,2; p = 0,008] foi preditor de TRS e a idade (RR 1,09; IC 95%, 1,04-1,15; p < 0,0001) e o não tratamento com bloqueador do receptor da angiotensina (BRA) (RR 4,18; IC 95%, 1,34-12,9; p = 0,01) foram preditores de ób-ito. A sobrevida renal e a geral dos pacientes foram de 70,9% e 68,6%, respectivamente. Conclusão: Neste estudo, os pacientes com DRC nos estágios 3-5 tratados conservadoramente apresentaram estabilização funcional e baixa mortalidade, desfechos associados à DRD, idade e não tratamento com BRA. Palavras-chave: Insuficiência renal crônica. Progressão da doença. Fatores de risco. AbstRActIntroduction: Chronic kidney disease (CKD) is a very common condition that has become a public health issue. Knowing more about risk factors associated with the progression of CKD allows therapeutic interventions that may change the natural course of the disease. Objective: To evaluate the impact of clinical and laboratory variables at admission on the outcomes death and need for renal replacement therapy (RRT). Methods: A retrospective cohort study comprised of 211 adult patients with stages 3-5 CKD, followed-up for 56.6 ± 34.5 months. Results: Mean age of patients was 65.4 ± 15.1 years and 63.5% were > 60 years. The main causes of CKD were hypertensive nephrosclerosis (29%) and diabetic kidney disease (DKD) (17%). Most patients (47.3%) were on stage 4 CKD. The mean annual loss of glomerular filtration rate (GFR) was 0.6 ± 2.5 mL/min/1.73 m 2 (median 0.77 mL/min/1.73 m 2 ) After the adjustments for demographic, clinical and laboratory variables, DKD [relative risk (RR) 4.4; 95% confidence interval (CI), 1.47 to 13.2; p = 0.008] was predictive of RRT; age (RR 1.09; 95% CI, 1.04 to 1.15; p < 0.0001) and the non-treatment with angiotensin receptor blocker (ARB) (RR 4.18, 95% CI, 1.34 to 12.9; p = 0.01) were predictors of death. Renal and patient survival rates were 70.9% and 68.6%, respectively. Conclusion: In t...

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Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)

Abstract: The proportion of patients with type 2 diabetes who develop microalbuminuria is substantial with one quarter affected by 10 years from diagnosis. Relatively fewer patients develop macroalbuminuria, but in those who do, the death rate exceeds the rate of progression to worse nephropathy.

Cited by 1,557 publications

References 49 publications

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Longitudinal Relationships among Coronary Artery Calcification, Serum Phosphorus, and Kidney Function

Associação entre fatores de risco clínicos e laboratoriais e progressão da doença renal crônica pré-dialítica

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