Use of Enalapril To Attenuate Decline in Renal Function in Normotensive, Normoalbuminuric Patients with Type 2 Diabetes Mellitus

Ravid, Mordchai; Brosh, David; Levi, Zohar; Bar‐Dayan, Yosefa; Ravid, Dorit; Rachmani, Rita

doi:10.7326/0003-4819-128-12_part_1-199806150-00004

Cited by 344 publications

(178 citation statements)

References 23 publications

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“…This is not the case in type 2 diabetic patients treated with ACEI, in whom our results show a better prognosis of renal function than was seen in patients treated with other antihypertensives. This finding is in agreement with previous evidences about favorable effects of ACEI on prevention of CKD in type 2 diabetes (30).…”

Section: Discussionsupporting

confidence: 83%

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

Segura¹,

Campo²,

Gil³

et al. 2004

Journal of the American Society of Nephrology

100

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Abstract. The existence of a significant percentage of treated hypertensive patients presenting a diminished renal function has been recently described. Mild renal function abnormalities are recognized as powerful predictors of cardiovascular morbidity and mortality. However, longitudinal data demonstrating this association are lacking. The objectives of this study have been analysis of the evolution of GFR, assessed as creatinine clearance (CrCl), during long-term follow-up of hypertensive patients and evaluation of the impact of the development of chronic kidney disease (CKD) on cardiovascular prognosis. A historical cohort of 281 patients attending our Hypertension Unit was selected according to the following criteria: essential hypertension, more than 5 yr of follow-up, and normal GFR at baseline (CrCl Ͼ 90 ml/min per 1.73 m 2 ). Patients had an average follow-up of 13.2 Ϯ 4.8 yr. Forty-one patients (14.6%) developed CKD (CrCl Ͻ 60 ml/min per 1.73 m 2 ) attributed to hypertensive nephrosclerosis. Initial serum creatinine, age, systolic BP at baseline, and average total cholesterol during follow-up were independent predictors of CKD development. Forty-nine (17.4%) of 281 patients presented a cardiovascular event during follow-up: 17 patients (40.6%) who developed CKD and 32 patients (13.3%) with preserved renal function (log rank test P Ͻ 0.001). After adjustment in a Cox multivariate analysis, age, development of CKD during follow-up, and male gender were independent predictors of the appearance of cardiovascular events. In essential hypertensive patients with normal renal function at baseline, the development of CKD during the follow-up is strongly and independently related with poor cardiovascular prognosis.The relation between elevated BP and end-stage renal disease (ESRD) is well established (1). In fact, high levels of treated BP are positively and significantly related to early decline in kidney function among hypertensive men (2), and hypertensive nephrosclerosis is recognized as a major cause of ESRD (3,4). The prevalence of chronic kidney disease (CKD) in essential hypertension has been considered to be low (Ͻ2%) on the basis of serum creatinine concentration as the index to estimate renal function (5,6). However, other evidences indicate that renal prognosis is not so benign in hypertensive patients (4,7-9) and that CKD is more prevalent than previously expected in treated essential hypertension (10 -12). Evaluation of renal function in long-term treated hypertensive patients has two main difficulties: first, the slow rate of progression to ESRD of nephrosclerosis, requiring very long follow-ups to investigate the evolution of renal function (4); second, the low discriminatory capacity of serum creatinine levels as an indicator of the renal filtration capacity and its changes with time (13,14). GFR is the best measure of overall renal function in health and disease (14). In clinical practice, measurement of creatinine clearance with 24-h urine collection is considered as an adequate estimate of GFR...

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Section: Discussionsupporting

confidence: 83%

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

Segura¹,

Campo²,

Gil³

et al. 2004

Journal of the American Society of Nephrology

100

View full text Add to dashboard Cite

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“…Nevertheless there is also recent evidence for additional BP-independent renoprotection by angiotensin receptor blocking agents and advanced (100,101) and early nephropathy of type 2 diabetes (31,102). In less rigorous trials, similar renoprotection, in part BP-independent, has previously also been shown for ACE inhibitors (103,104), including a study documenting benefit on renal histology (105). Attempts at achieving these BP targets must be tempered by the observation that in the IDNT trial (101) the renal risk increased progressively as BP in the orthostatic position was lower, possibly because of injury from intermittent renal underperfusion potentially explained by reduced ischemia tolerance of the diabetic kidney (106).…”

Section: Prevention Of Progressionmentioning

confidence: 98%

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Wolf¹,

Ritz²

2003

Journal of the American Society of Nephrology

101

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“…The benefit of blocking the RAAS with ACEi and ARBs in a variety of kidney diseases, including DN, is now well established. [63][64][65][66][67][68][69][70] However, such treatment does not completely abrogate the progression of kidney disease. [69][70][71] This partial response has been attributed in part to feedback effects, such as angiotensin-escape and aldosteroneescape.…”

Section: Blood Pressure Controlmentioning

confidence: 99%

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

et al. 2011

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Diabetes mellitus is the leading cause of end stage renal disease and is responsible for more than 40% of all cases in the United States. Current therapy directed at delaying the progression of diabetic nephropathy includes intensive glycemic and optimal blood pressure control, proteinuria/albuminuria reduction, interruption of the renin-angiotensin-aldosterone system through the use of angiotensin converting enzyme inhibitors and angiotensin type-1 receptor blockers, along with dietary modification and cholesterol lowering agents. However, the renal protection provided by these therapeutic modalities is incomplete. More effective approaches are urgently needed. This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner.

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Use of Enalapril To Attenuate Decline in Renal Function in Normotensive, Normoalbuminuric Patients with Type 2 Diabetes Mellitus

Abstract: Enalapril attenuated the decline in renal function and reduced the extent of albuminuria in normotensive, normoalbuminuric patients with type 2 diabetes. Further research is needed to determine whether this treatment forestalls the development of overt nephropathy.

Cited by 344 publications

References 23 publications

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

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