Have we reached the limits for the treatment of diabetic nephropathy?

Hajhosseiny, Reza; Khavandi, Kaivan; Jivraj, Naheed; Mashayekhi, Soudeh; Goldsmith, David; Malik, Rayaz A.

doi:10.1517/13543784.2014.892580

Cited by 22 publications

(14 citation statements)

References 109 publications

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“…Treatment regimens commonly include RAAS-blocking agents such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). However, these therapies are considered to be inadequate for the treatment of diabetic nephropathy, as they do not reverse the disease [9, 10]. Treatment combinations, such as dual-RAAS blockade with ACE inhibitors and ARBs, have been considered, but they are associated with adverse events (e.g., hyperkalemia and acute kidney injury); thus, these treatment combinations are not recommended, and are contraindicated in patients with renal impairment [8, 11].…”

Section: Introductionmentioning

confidence: 99%

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

et al. 2017

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IntroductionDiabetic nephropathy (DN) is a progressive kidney disease resulting as a complication of diabetes mellitus. This study evaluated the disease progression and economic burden of DN among commercially insured patients with type 2 diabetes in the USA.MethodsThe research design was a retrospective observational study based on healthcare claims data. The Truven MarketScan Databases (2004–2014) were queried for adults with type 2 diabetes with at least one urine albumin test (index, randomly selected) after diagnosis and at least one test after the index. On the basis of the index test, patients were classified into normoalbuminuria, microalbuminuria, or macroalbuminuria groups. Nephropathy-related treatment use was measured in the 6 months after the index, disease progression was assessed from the index to the end of data availability, and annual all-cause and nephropathy-related costs and healthcare resource use (HRU) were assessed up to 2 years from the index. Outcomes were compared between any two groups, controlling for baseline demographics.ResultsA total of 23,235 patients were identified and classified into normoalbuminuria (N = 18,409), microalbuminuria (N = 3863), or macroalbuminuria (N = 963) groups. Patients with albuminuria were more likely to be older, male, and have a higher burden of baseline comorbidities and HRU. Within 6 months following the index, 12–20% of patients with albuminuria were not treated with any relevant recommended treatment. Compared to the normoalbuminuria group, patients with macroalbuminuria had a significantly greater risk of disease progression (hazard ratio [HR] = 1.44), and both albuminuria groups were more likely to require dialysis (HR = 4.23 and 40.14 for micro- and macroalbuminuria, respectively; all p < 0.05). Annual all-cause (2016 US dollars, $3580 and $12,830 higher for micro- and macroalbuminuria vs. normoalbuminuria, respectively) and nephropathy-related ($362 and $3716) costs increased significantly with increasing nephropathy severity, consistent with the trend in increased HRU.ConclusionsDiabetic nephropathy may be undertreated or inappropriately treated. It was also associated with significantly higher costs, HRU, and risk of disease progression among commercially insured patients with type 2 diabetes in the USA.FundingTakeda Development Center Americas, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0256-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

et al. 2017

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“…However, clinical data show that intensive glycemic and hypertension control has limited therapeutic effectiveness for DN (Parving et al, 2012;Fried et al, 2013;Gentile et al, 2014;Hajhosseiny et al, 2014). Additional studies are also needed to determine if AC261 can reverse renal damage associated with DN since in this work we are measuring the ability of the drug to inhibit the development of DN.…”

Section: Downloaded Frommentioning

confidence: 99%

Amelioration of Diabetic Nephropathy Using a Retinoic Acid Receptorβ2 Agonist

Trasino

Tang

Shevchuk

et al. 2018

J Pharmacol Exp Ther

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“…AGEs 的异常积累是 DPN 发生发展的重要病理机制 [9] ，甚至在糖尿病的各种并发症患者中均发现了 AGEs 水平的升高 [10] ，长期高血糖可使周围神经的结构和功能蛋白发生糖基化，生成更多 AGEs，AGEs 与特定的受体结合，导致一系列神经功能障碍。吡哆胺作为维生素 B 6 的天然成分，可以抑制 AGEs 的生成，有着治疗糖尿病肾病和 DPN 的广阔前景 [11] 。同时，研究者发现一些常用药物也有抑制 AGEs 的作用，如阿卡波糖、二甲双胍、维生素 C、替尼西坦等 [12] 。…”

Section: 高级糖基化产物(Ages)抑制药unclassified

糖尿病周围神经病变的药物与非药物治疗进展

et al. 2015

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Diabetic peripheral neuropathy(DPN) is one of the common chronic complications in diabetic patients. Patients with DPN present variable symptoms and physical findings, ranging from asymptomatic loss of tendon reflex to severe painful neuropathy, even lead to disability. It seriously lower the quality of diabetic patients' life. Because of its etiology and pathogenesis were not yet fully understood, the treatment has been tending to diversification. Strict glycemic control is a precondition, then we shuold focus on the elimination of the etiology, relieve the symptoms, prevention and treatment the complications.Such as improving vascular function, adjusting the metabolic disorders, relieving pain and other methods. Due to the limitations of western drug treatment, also, non-drug treatment is easy to operate with clear effect and little side effects, current studies of non-drug treatment tend to increase gradually, such as electric acupuncture therapy, autologous bone marrow stem cells implantation, hyperbaric oxygen therapy and other methods．The combination of drug and non-drug treatment can improve the curative effect of DPN. This review summarize the progress of drug and non-drug treatment for DPN in the recent years.

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Have we reached the limits for the treatment of diabetic nephropathy?

Cited by 22 publications

References 109 publications

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study

Amelioration of Diabetic Nephropathy Using a Retinoic Acid Receptorβ2 Agonist

糖尿病周围神经病变的药物与非药物治疗进展

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