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04-04-2013 | Nephrology | Article

Risk factors identify renal events in diabetic nephropathy


Free abstract

medwireNews: Increasing proteinuria or albuminuria and decreasing estimated glomerular filtration rate (eGFR) over a 2-year period predict a high likelihood of renal events among patients with Type 2 diabetic nephropathy who are stabilized on angiotensin receptor blockers (ARBs).

The findings that increasing protein/creatinine ratio (PCR) or albumin/creatinine ratio (ACR), and decreasing eGFR, are associated with an increased risk for poor renal outcomes are consistent with findings from other studies.

"This assessment of risk assists clinical management, for example in guiding timing of the establishment of chronic vascular access and of possible preemptive transplantation," write Sara Ivory (Monash University, Melbourne, Victoria, Australia) and co-authors in Nephrology.

The researchers investigated the time from baseline to first occurrence of any one of: a doubling of baseline serum creatinine concentration; the onset of end-stage renal disease, which was defined as initiation of dialysis, renal transplantation, or a serum creatinine concentration of at least 6.0 mg/dL; or death from any cause.

In total, 1245 patients stabilized on ARB therapy were assessed and followed up for an average of 432 days.

During follow-up, 7.1% of patients had significant progression of their renal disease, with progression risk increasing across ranges of PCR values in patients within the lowest eGFR range (15-29 mL/min per 1.73 m2). These results were similar to those seen with ACR categories.

Compared with patients who had an eGFR in the highest range of 45-59 mL/min per 1.73 m2, those with an eGFR of 15-29 mL/min per 1.73 m2 were 4.7-fold more likely to show renal disease progression, a significant increase. Similarly, patients with a PCR of 2000 mg/g or above had a significant 5.4-fold increase in their chances of disease progression compared with patients with a PCR below 1000 mg/g.

When the team repeated the analysis with ACR in place of PCR, findings were similar for eGFR ranges (hazard ratio [HR=4.7) and for ACR categories (HR=4.0). Mortality incidence rates were also found to increase in line with increasing PCR/ACR and decreasing eGFR, but were not as high as those seen for renal progression.

Factors such as blood pressure, race, age, and gender did not significantly affect the PCR/ACR and eGFR relationships with renal disease progression.

"Assessment of the likelihood of a significant renal event in the mid-term in patients already receiving best therapy is essential in the design and planning of trials of additional therapies that may have benefits on outcome," conclude the researchers.

By Ingrid Grasmo, medwireNews Reporter