Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy

Atkins, Robert C.; Briganti, Esther M.; Lewis, Julia B.; Hunsicker, Lawrence G.; Braden, Gregory; Crespigny, Paul J. Champion de; Deferrari, Giacomo; Drury, Paul; Locatelli, Francesco; Wiegmann, Thomas; Lewis, Edmund J.

doi:10.1053/j.ajkd.2004.10.019

Cited by 320 publications

(242 citation statements)

References 23 publications

Supporting

Mentioning

206

Contrasting

Unclassified

Order By: Relevance

“…34,40,[46][47][48][56][57][58][59] Clinical trials, grouped by the degree of albuminuria, demonstrating the beneficial effects of RAAS inhibition on renal end points in patients with diabetes mellitus are summarized in Table 2. 34,40,42,48,49,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Normoalbuminuria The Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) is the only primary prevention study to date to demonstrate that the development of microalbuminuria can be prevented by the use of an ACE inhibitor alone or in combination with a CCB in hypertensive normoalbuminuric patients with type II diabetes. 59 …”

Section: Clinical Evidence Of Benefits Of Raas Inhibition In Patientsmentioning

confidence: 99%

“…These results were independent of the small BP differences between study arms. 48 The IDNT, 49,62 in patients with type II diabetes and proteinuria, demonstrated that a reduction in albuminuria during antihypertensive treatment is associated with reduction in progression of nephropathy and development of ESRD. Indeed, IDNT found that halving proteinuria by 12 months of treatment reduced the risk of kidney failure by half.…”

Section: Microalbuminuriamentioning

confidence: 99%

“…72 Results from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study 73 and from IDNT 62 suggest that a reduction in albuminuria during antihypertensive treatment is associated with a reduction in the risk of cardiovascular events as well as reduction in progression of nephropathy and development of ESRD.…”

Section: Microalbuminuriamentioning

confidence: 99%

“…57 ARB and CCB treatment were directly compared in IDNT. 49,62 Irbesartan decreased the risk of doubling of serum creatinine by 37% compared with amlodipine (Po0.001) and by 33% compared with placebo (P ¼ 0.003). At 12 months, proteinuria decreased by 41, 11, and 16% in the ARB, CCB, and placebo groups, respectively.…”

Section: Years (Mean)mentioning

confidence: 99%

See 3 more Smart Citations

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

View full text Add to dashboard Cite

The incidence of end-stage renal disease (ESRD) is rising worldwide, accompanied by corresponding increases in the risk of morbidity and mortality. Underlying this trend are increasing rates of hypertension and diabetes mellitus, the two most common causes of ESRD. In addition to the adverse haemodynamic effects of hypertension on the kidney, elevated blood pressure (BP) can activate components of the renin-angiotensinaldosterone system (RAAS), which, in turn, activate mediators of inflammation, oxidative stress, cell growth, and matrix accumulation. Lowering BP reduces the risk of cardiovascular events and renal damage. Accumulating evidence from clinical and laboratory studies suggests that interrupting the RAAS with therapies such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone receptor blockers can interfere with the mechanisms that promote diabetic and non-diabetic renal damage. Moreover, clinical trials of RAAS blockade have demonstrated reductions in microalbuminuria, a predictor of increased cardiorenal risk and overt nephropathy in patients with and without diabetes and/or hypertension. In this way, agents that block the RAAS should be considered the drugs of first choice as they provide enhanced renoprotection compared with other classes of antihypertensive agents such as calcium channel blockers and b-blockers.

show abstract

Section: Clinical Evidence Of Benefits Of Raas Inhibition In Patientsmentioning

confidence: 99%

Section: Microalbuminuriamentioning

confidence: 99%

Section: Microalbuminuriamentioning

confidence: 99%

Section: Years (Mean)mentioning

confidence: 99%

See 2 more Smart Citations

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

View full text Add to dashboard Cite

show abstract

“…14 Moreover, in post hoc analyses of three separate studies, the magnitude of change in proteinuria at 6 months determined renal outcome at 3-5 years; an effect that could not be explained by changes in blood pressure alone. [15][16][17] Thus, guidelines recommend agents that block the RAAS be part of an antihypertensive regimen in chronic kidney disease patients to not only lower blood pressure but reduce proteinuria. 7,8 Whereas proteinuria (i.e.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of a study to evaluate management of proteinuria in patients at high risk for vascular events: the IMPROVE trial

et al. 2006

View full text Add to dashboard Cite

Declining kidney function predicts increasing cardiovascular risk in people with hypertension. Microalbuminuria is a marker for cardiovascular risk and declining kidney function. Agents that block the renin-angiotensin-aldosterone system (RAAS), notably angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), reduce proteinuria and microalbuminuria, lower blood pressure and slow the progression of proteinuric kidney disease. Evidence is accumulating that the combination of an ACE inhibitor and an ARB is the optimal means of RAAS blockade in this setting, slowing the progression of nephropathy independently of blood pressure lowering to a greater degree than can be achieved using maximum approved doses of either agent alone. However, the emerging therapeutic potential of ACE inhibitor/ARB combination therapy in hypertensive kidney disease requires further characterization. The Irbesartan in the Management of PROteinuric patients at high risk for Vascular Events trial aims to determine definitively whether the combination therapy of an ARB, irbesartan and an ACE inhibitor, ramipril, is more effective than ramipril alone in reducing the urinary albumin excretion rate in patients at high cardiovascular risk with hypertension and proteinuria or microalbuminuria.

show abstract

Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease

Natale,

Palmer,

Navaneethan

et al. 2024

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy

Cited by 320 publications

References 23 publications

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Rationale and design of a study to evaluate management of proteinuria in patients at high risk for vascular events: the IMPROVE trial

Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease

Contact Info

Product

Resources

About