Diabetic nephropathy secondary prevention: Difference between revisions
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** The Cochrane reported, "presence (versus absence) of hypertension in the enrolled populations did not significantly impact...doubling of serum creatinine (interaction P value = 0.22)"<ref name="pmid17054288"/> However, the Cochrane did not report the data underlying this analysis. | ** The Cochrane reported, "presence (versus absence) of hypertension in the enrolled populations did not significantly impact...doubling of serum creatinine (interaction P value = 0.22)"<ref name="pmid17054288"/> However, the Cochrane did not report the data underlying this analysis. | ||
** The KDIGO guideline reports that only two trials included patients without [[hypertnesion]] (RENAAL<ref name="pmid11565518">{{cite journal| author=Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH | display-authors=etal| title=Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 12 | pages= 861-9 | pmid=11565518 | doi=10.1056/NEJMoa011161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11565518 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=11985425 Review in: ACP J Club. 2002 May-Jun;136(3):82-4] </ref> and INNOVATION<ref name="pmid18633177">{{cite journal| author=Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y | display-authors=etal| title=Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. | journal=Hypertens Res | year= 2008 | volume= 31 | issue= 4 | pages= 657-64 | pmid=18633177 | doi=10.1291/hypres.31.657 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18633177 }} </ref>). The INNOVATION trial reported significant reduction in urine microalbuminuria from [[telmisartan]] regardless of whether hypertension was present<ref name="pmid18633177"/>. | ** The KDIGO guideline reports that only two trials included patients without [[hypertnesion]] (RENAAL<ref name="pmid11565518">{{cite journal| author=Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH | display-authors=etal| title=Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 12 | pages= 861-9 | pmid=11565518 | doi=10.1056/NEJMoa011161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11565518 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=11985425 Review in: ACP J Club. 2002 May-Jun;136(3):82-4] </ref> and INNOVATION<ref name="pmid18633177">{{cite journal| author=Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y | display-authors=etal| title=Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. | journal=Hypertens Res | year= 2008 | volume= 31 | issue= 4 | pages= 657-64 | pmid=18633177 | doi=10.1291/hypres.31.657 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18633177 }} </ref>). The INNOVATION trial reported significant reduction in urine microalbuminuria from [[telmisartan]] regardless of whether hypertension was present<ref name="pmid18633177"/>. | ||
* Canagliflozin, SGLT-2 inhibitors, reduces the risk of kidney failure and cardiovascular events in a [[randomized control trial]] of patients with diabetic kidney disease (urinary albumin-to-creatinine ratio < 300) who were almost all hypertensive and already taking [[ACE inhibitor]]s.<ref name="pmid30990260">{{cite journal| author=Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM | display-authors=etal| title=Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 24 | pages= 2295-2306 | pmid=30990260 | doi=10.1056/NEJMoa1811744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30990260 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=31366588 Review in: BMJ Evid Based Med. 2020 Apr;25(2):79-80] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=31426058 Review in: Ann Intern Med. 2019 Aug 20;171(4):JC15] </ref>. | |||
* Canagliflozin, SGLT-2 inhibitors, reduces the risk of kidney failure and cardiovascular events in a [[randomized control trial]] of patients with diabetic kidney disease who were almost all hypertensive and already taking [[ACE inhibitor]]s.<ref name="pmid30990260">{{cite journal| author=Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM | display-authors=etal| title=Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. | journal=N Engl J Med | year= 2019 | volume= 380 | issue= 24 | pages= 2295-2306 | pmid=30990260 | doi=10.1056/NEJMoa1811744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30990260 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=31366588 Review in: BMJ Evid Based Med. 2020 Apr;25(2):79-80] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=31426058 Review in: Ann Intern Med. 2019 Aug 20;171(4):JC15] </ref>. | |||
==References== | ==References== | ||
Revision as of 21:26, 15 June 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Once diabetic nephropathy develops, secondary prevention to halt the progression of the disease is aimed at strict control of blood pressure, blood glucose levels, as well as lipids.
Secondary Prevention
Once diabetic nephropathy develops, secondary prevention to halt the progression of the disease is aimed at:
- The benefits of tight control of blood glucose levels are uncertain per a systematic review by the Cochrane Collaboration[1].
- Strict control of blood pressure, as well as lipids.[2]
- Regarding ACE inhibitors, the Cochrane Collaboration reported reduction in renal outcomes[3]. Whether this applies to patients without hypertensino is unclear:
- The Cochrane reported, "presence (versus absence) of hypertension in the enrolled populations did not significantly impact...doubling of serum creatinine (interaction P value = 0.22)"[3] However, the Cochrane did not report the data underlying this analysis.
- The KDIGO guideline reports that only two trials included patients without hypertnesion (RENAAL[4] and INNOVATION[5]). The INNOVATION trial reported significant reduction in urine microalbuminuria from telmisartan regardless of whether hypertension was present[5].
- Canagliflozin, SGLT-2 inhibitors, reduces the risk of kidney failure and cardiovascular events in a randomized control trial of patients with diabetic kidney disease (urinary albumin-to-creatinine ratio < 300) who were almost all hypertensive and already taking ACE inhibitors.[6].
References
- ↑ Ruospo M, Saglimbene VM, Palmer SC, De Cosmo S, Pacilli A, Lamacchia O; et al. (2017). "Glucose targets for preventing diabetic kidney disease and its progression". Cochrane Database Syst Rev. 6: CD010137. doi:10.1002/14651858.CD010137.pub2. PMC 6481869. PMID 28594069. Review in: Ann Intern Med. 2017 Oct 17;167(8):JC47 Review in: Evid Based Med. 2017 Dec;22(6):219-220
- ↑ Chamberlain JJ, Rhinehart AS, Shaefer CF, Neuman A (2016). "Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes". Ann. Intern. Med. 164 (8): 542–52. doi:10.7326/M15-3016. PMID 26928912.
- ↑ 3.0 3.1 Strippoli GF, Bonifati C, Craig M, Navaneethan SD, Craig JC (2006). "Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease". Cochrane Database Syst Rev (4): CD006257. doi:10.1002/14651858.CD006257. PMC 6956646 Check
|pmc=value (help). PMID 17054288. - ↑ Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH; et al. (2001). "Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy". N Engl J Med. 345 (12): 861–9. doi:10.1056/NEJMoa011161. PMID 11565518. Review in: ACP J Club. 2002 May-Jun;136(3):82-4
- ↑ 5.0 5.1 Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y; et al. (2008). "Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study". Hypertens Res. 31 (4): 657–64. doi:10.1291/hypres.31.657. PMID 18633177.
- ↑ Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM; et al. (2019). "Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy". N Engl J Med. 380 (24): 2295–2306. doi:10.1056/NEJMoa1811744. PMID 30990260. Review in: BMJ Evid Based Med. 2020 Apr;25(2):79-80 Review in: Ann Intern Med. 2019 Aug 20;171(4):JC15