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 language | English |
|---|---|
| Pages (from-to) | 64-71 |
| Number of pages | 8 |
| Journal | Diabetes, Obesity and Metabolism |
| Volume | 18 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2016 |
Fingerprint
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 journal › Article
}
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 -