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Study: Advances in kidney disease care not benefiting diabetes patients

Issue: May 2011

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Despite an increase of available renoprotective treatments, patients with type 1 diabetes and macroalbuminuria remain at high risk for end-stage renal disease, researchers at Joslin Diabetes Center found.

From 1991 to 2004, researchers enrolled 423 white patients with type 1 diabetes who also had macroalbuminuria (album excretion rate, ≥300 mcg/minute). According to an accompanying editorial by Robert G. Nelson, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, the incidence rate of ESRD in black patients is about fourfold higher than in white patients.

The 15-year span of enrollment was divided into three 5-year sub-cohorts: 1991 to 1995; 1996 to 2000; and 2001 to 2004. Follow-up was conducted on 98% of the cohort through 2008; ESRD was found in 172 patients (incidence rate, 5.8 per 100 person-years) and 29 mortalities without ESRD (1 per 100 person-years). A median age trend in these patients equaled 34 to 42 years (P<.0001) and was paralleled by longer type 1 diabetes duration (23 to 27 years, P=.61 adjusted for age). Cumulative risk for ESRD during the follow-up period was 52%, and it was 11% for pre-ESRD death.

The use of renoprotective treatment during the follow-up period increased from 56% to 82%. Several characteristics changed, independent of age: BMI increased (P<.001); use of lipid-lowering drugs increased (P<.0016); total cholesterol improved (P=.0001); and blood pressure decreased (systolic: 137 mm Hg to 131 mm Hg, P<.0016; diastolic: 81 mm Hg to 76 mm Hg, P=.0001). However, risks for ESRD and pre-ESRD death did not change.

“Our findings clearly indicate that the accomplishments in treatment of patients with type 1 diabetes and macroalbuminuria over the last 20 years are not effective enough, and more effective therapies to retard progression to ESRD are desperately needed,” Andrzej S. Krolewski, MD, PhD, a study researcher, said in a press release.

For more information:

• Nelson RG. J Am Soc Nephrol. 2011;doi:10.1681/ASN.2011010076.
• Rosolowsky ET. J Am Soc Nephrol. 2011;doi:10.1681/ASN.2010040354.

Disclosure: The researchers report no relevant financial disclosures.

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