Nephrology Dialysis Transplantation, Vol 13, Issue 3 651-655, Copyright © 1998 by Oxford University Press
H Mulec, G Blohme, B Grande and S Bjorck
Background: Strict glycaemic control has been shown to
reduce the risk of developing diabetic nephropathy. In established
nephropathy, however, the impact of glycaemic control on prognosis is less
clear. Therefore we investigated the effect of long-term glycaemic control
on the decline in renal function in insulin-dependent diabetic patients
with overt nephropathy. Methods: The study was
performed at two hospital-based diabetes centres in western Sweden. The
study was an observational retrospective follow-up study in 158
insulin-dependent diabetics with proteinuria with a mean (±SD)
age of 36±9 years and a diabetes duration of 22±8
years. The change in glomerular filtration rate was measured as
51Cr EDTA clearance for a
median of 8 years (range 1-17). Glycaemic control was determined with
measurements of glycated haemoglobin A1c. Results: The
decline in glomerular filtration rate was 3.8±3.7 ml/min/year.
The blood pressure was 143/82±15/7 mmHg and the mean glycated
haemoglobin was 8.7±1.6%. The correlation coefficient between
glycated haemoglobin and decline in glomerular filtration rate was -0.39
(P<0.0001) and between decline in glomerular filtration rate and
systolic and diastolic blood pressure -0.17 (P=0.03) and -0.29 (P=0.003)
respectively. In patients with glycated haemoglobin <8.0% and
diastolic blood pressure <85 mmHg the decline in glomerular
filtration rate was 1.7±2.3 ml/min/year.
Conclusions: In this retrospective observational
study, effective blood-pressure control was associated with a low rate of
decline in renal function and a low urinary albumin excretion. The
correlation between glycaemic control and decline in renal function
indicates that poor glycaemic control can accelerate the loss of renal
function in diabetic nephropathy. Key words: blood
pressure; diabetic nephropathy; glomerular filtration rate; glycaemic
control; insulin-dependent diabetes mellitus; renal failure
ORIGINAL ARTICLES
The effect of metabolic control on rate of decline in renal function in insulin-dependent diabetes mellitus with overt diabetic nephropathy
Department of Nephrology, Northern Alvsborg County Hospital, Trollhattan, Sweden; Departments of Internal Medicine, and Nephrology, Sahlgrenska Hospital, University of Goteborg, S-413 45 Goteborg, Sweden; Corresponding author
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