Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes

B. Schievink, T. Kröpelin, S. Mulder, H. H. Parving, G. Remuzzi, J. Dwyer, P. Vemer, D. de Zeeuw, H. J. Lambers Heerspink

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Aims: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. Methods: We used data from the BENEDICT, IRMA-2, RENAAL and IDNT trials that assessed effects of RAS intervention in patients with type 2 diabetes. We built a model with discrete disease stages based on albuminuria and estimated glomerular filtration rate (eGFR). Using survival analyses, we assessed the effect of RAS intervention on delaying ESRD in early [eGFR>60ml/min/1.73m2 and albumin:creatinine ratio (ACR) 2 or ACR 30-300mg/g) and advanced (eGFR 2 or ACR >300mg/g) stages of DKD for patients in different age groups. Results: For patients at early, intermediate and advanced stage of disease, whose mean age was 60years and who received placebo, the median time to ESRD was 21.4, 10.8 and 4.7years, respectively. RAS intervention delayed the predicted time to ESRD by 4.2, 3.6 and 1.4years, respectively. The benefit of early RAS intervention was more pronounced in younger patients; for example, for patients with a mean age of 45years, RAS intervention at early, intermediate or advanced stage delayed ESRD by 5.9, 4.0 and 1.1years versus placebo. Conclusions: RAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD.

Original languageEnglish
Pages (from-to)64-71
Number of pages8
JournalDiabetes, Obesity and Metabolism
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Renin-Angiotensin System
Type 2 Diabetes Mellitus
Chronic Kidney Failure
Diabetic Nephropathies
Glomerular Filtration Rate
Albumins
Creatinine
Placebos
Albuminuria
Survival Analysis
Age Groups

Keywords

  • Albuminuria
  • Kidney disease
  • RAS inhibitors
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes. / Schievink, B.; Kröpelin, T.; Mulder, S.; Parving, H. H.; Remuzzi, G.; Dwyer, J.; Vemer, P.; de Zeeuw, D.; Lambers Heerspink, H. J.

In: Diabetes, Obesity and Metabolism, Vol. 18, No. 1, 01.01.2016, p. 64-71.

Research output: Contribution to journalArticle

Schievink, B. ; Kröpelin, T. ; Mulder, S. ; Parving, H. H. ; Remuzzi, G. ; Dwyer, J. ; Vemer, P. ; de Zeeuw, D. ; Lambers Heerspink, H. J. / Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes. In: Diabetes, Obesity and Metabolism. 2016 ; Vol. 18, No. 1. pp. 64-71.
@article{355f74c7c9df4aa685ba8471d6a6cd2d,
title = "Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes",
abstract = "Aims: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. Methods: We used data from the BENEDICT, IRMA-2, RENAAL and IDNT trials that assessed effects of RAS intervention in patients with type 2 diabetes. We built a model with discrete disease stages based on albuminuria and estimated glomerular filtration rate (eGFR). Using survival analyses, we assessed the effect of RAS intervention on delaying ESRD in early [eGFR>60ml/min/1.73m2 and albumin:creatinine ratio (ACR) 2 or ACR 30-300mg/g) and advanced (eGFR 2 or ACR >300mg/g) stages of DKD for patients in different age groups. Results: For patients at early, intermediate and advanced stage of disease, whose mean age was 60years and who received placebo, the median time to ESRD was 21.4, 10.8 and 4.7years, respectively. RAS intervention delayed the predicted time to ESRD by 4.2, 3.6 and 1.4years, respectively. The benefit of early RAS intervention was more pronounced in younger patients; for example, for patients with a mean age of 45years, RAS intervention at early, intermediate or advanced stage delayed ESRD by 5.9, 4.0 and 1.1years versus placebo. Conclusions: RAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD.",
keywords = "Albuminuria, Kidney disease, RAS inhibitors, Type 2 diabetes",
author = "B. Schievink and T. Kr{\"o}pelin and S. Mulder and Parving, {H. H.} and G. Remuzzi and J. Dwyer and P. Vemer and {de Zeeuw}, D. and {Lambers Heerspink}, {H. J.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1111/dom.12583",
language = "English",
volume = "18",
pages = "64--71",
journal = "Diabetes, Obesity and Metabolism",
issn = "1462-8902",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes

AU - Schievink, B.

AU - Kröpelin, T.

AU - Mulder, S.

AU - Parving, H. H.

AU - Remuzzi, G.

AU - Dwyer, J.

AU - Vemer, P.

AU - de Zeeuw, D.

AU - Lambers Heerspink, H. J.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Aims: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. Methods: We used data from the BENEDICT, IRMA-2, RENAAL and IDNT trials that assessed effects of RAS intervention in patients with type 2 diabetes. We built a model with discrete disease stages based on albuminuria and estimated glomerular filtration rate (eGFR). Using survival analyses, we assessed the effect of RAS intervention on delaying ESRD in early [eGFR>60ml/min/1.73m2 and albumin:creatinine ratio (ACR) 2 or ACR 30-300mg/g) and advanced (eGFR 2 or ACR >300mg/g) stages of DKD for patients in different age groups. Results: For patients at early, intermediate and advanced stage of disease, whose mean age was 60years and who received placebo, the median time to ESRD was 21.4, 10.8 and 4.7years, respectively. RAS intervention delayed the predicted time to ESRD by 4.2, 3.6 and 1.4years, respectively. The benefit of early RAS intervention was more pronounced in younger patients; for example, for patients with a mean age of 45years, RAS intervention at early, intermediate or advanced stage delayed ESRD by 5.9, 4.0 and 1.1years versus placebo. Conclusions: RAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD.

AB - Aims: To develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end-stage renal disease (ESRD), and to assess the effect of renin-angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD. Methods: We used data from the BENEDICT, IRMA-2, RENAAL and IDNT trials that assessed effects of RAS intervention in patients with type 2 diabetes. We built a model with discrete disease stages based on albuminuria and estimated glomerular filtration rate (eGFR). Using survival analyses, we assessed the effect of RAS intervention on delaying ESRD in early [eGFR>60ml/min/1.73m2 and albumin:creatinine ratio (ACR) 2 or ACR 30-300mg/g) and advanced (eGFR 2 or ACR >300mg/g) stages of DKD for patients in different age groups. Results: For patients at early, intermediate and advanced stage of disease, whose mean age was 60years and who received placebo, the median time to ESRD was 21.4, 10.8 and 4.7years, respectively. RAS intervention delayed the predicted time to ESRD by 4.2, 3.6 and 1.4years, respectively. The benefit of early RAS intervention was more pronounced in younger patients; for example, for patients with a mean age of 45years, RAS intervention at early, intermediate or advanced stage delayed ESRD by 5.9, 4.0 and 1.1years versus placebo. Conclusions: RAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD.

KW - Albuminuria

KW - Kidney disease

KW - RAS inhibitors

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=84955189351&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955189351&partnerID=8YFLogxK

U2 - 10.1111/dom.12583

DO - 10.1111/dom.12583

M3 - Article

AN - SCOPUS:84955189351

VL - 18

SP - 64

EP - 71

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

SN - 1462-8902

IS - 1

ER -