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【medical-news】2010EASD会讯——早期发现白蛋白尿有助于减缓糖尿病肾病进展

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Progression of Diabetic Nephropathy Slowed With Early Detection of Albuminuria

September 30, 2010 (Stockholm, Sweden) — A study of more than 11,000 adults with hypertension and type 2 diabetes, presented here at the European Association for the Study of Diabetes 46th Annual Meeting, showed that the lifetime risk for nephropathy and its progression might be greater than previously thought. In addition, results showed that the use of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) was not optimal in this population, indicating that there might be room for improvement in strategies to reduce the burden of disease.

Epidemiologist Suma Vupputuri, PhD, MPH, from Kaiser Permanente Center for Health Research/Southeast in Atlanta, Georgia, said that estimates that one third of diabetic patients develop nephropathy are from a time when glycemic thresholds for the diagnosis of diabetes were higher than today, and before aggressive treatment was shown to reduce renal complications.

She said because nephropathy is a major cause of cardiovascular disease and end-stage renal disease, it is important to understand the progression from normal levels of albumin excretion to micro- and macroalbuminuria, and to define the risk factors associated with nephropathy progression.

The researchers studied type 2 diabetes patients with hypertension (n = 11,562) who were 18 years or older and for whom there were urine albumin-to-creatinine ratios (UACR) documented in 2001, 2002, or 2003, and at least 1 additional UACR 3 to 8 years later.

The baseline stages of nephropathy were defined by the UACR: a ratio below 30 μg/mg was considered normal, from 30 to 299 μg/mg indicated microalbuminuria, and 300 μg/mg or above indicated macroalbuminuria. Progression was defined as the first UACR value recorded in a stage higher than that seen at the baseline. Patients were censored if they died or left the health plan.

Over 89 months of follow-up, the incidence of progression of nephropathy was highest for people with normal baseline UACRs, followed by patients with microalbuminuria, and then macroalbuminuria (94.6, 44.1, and 6.7 per 1000 patient-years, respectively).

"Among patients with normal albumin at baseline, those who progressed to a higher stage of nephropathy were in general older, had a longer duration of diabetes, had higher mean blood pressures, and had higher HbA1cs [glycated haemoglobin]," Dr. Vupputuri said. The patients with microalbuminuria at baseline who progressed were more likely to be male, had longer durations of diabetes, had higher mean blood pressures, and had higher HbA1c levels. The macroalbuminuria group had risk factors similar to the microalbuminuria group, and had lower glomerular filtration rates (GFRs) and a diagnosis of cardiovascular disease or heart failure.

Across the stratified baseline cohorts, 78% to 91% of patients were receiving antihypertensive agents, and about half were receiving statins. Most were receiving antihyperglycemic drugs (range, 67% to 79%). The use of insulin went up and oral agents down with increasing nephropathy stage.

ACE inhibitor or ARB use ranged from 61% to 67% for all baseline groups, whether they progressed or not, with one notable exception. Of patients with baseline macroalbuminuria who progressed, ACE inhibitor or ARB use was only 38%.

From the 3 Cox regression models that identified risk factors for time to progression for each baseline cohort, it emerged that ACE inhibitor or ARB use was not a significant factor for patients with normal albumin levels or microalbuminuria at baseline.

However, for patients with baseline macroalbuminuria, the use of these drugs conferred a multivariate hazard ratio (HR) of 0.53 (95% confidence interval [CI], 0.29 - 0.95), meaning their use reduced the risk for progression by 47%. Similarly, age conferred a 21% benefit per 5 years (HR, 0.79 per 5 years; 95% CI, 0.66 - 0.95), as did estimated GFR, with a 65% risk reduction for every increase of 10 mL/min per 1.73 m2 (HR, 0.35; 95% CI, 0.27 - 0.48).

Dr. Vupputuri summarized by saying that of the entire baseline cohort, 41% had prevalent micro- or macroalbuminuria, and 68% with a normal starting level developed micro- or macroalbuminuria.

Predictors of progression of nephropathy included age, race (being African American was somewhat protective), diabetes duration, systolic and diastolic blood pressure, HbA1c level, body mass index, estimated GFR, ACE inhibitor/ARB use, and cardiovascular disease.

A limitation of the study is its possible lack of generalizability; it was restricted to patients with diabetes, hypertension, and health insurance who had multiple determinations of UACR. Furthermore, estimates of risk for progression could have been biased by patients who died before their nephropathy might have progressed. Finally, individual variation in albumin excretion and serum creatinine production could have influenced the results.

Dr. Vupputuri concluded that the progression of diabetic nephropathy found here was higher than previously reported. "The use of ACE [inhibitors] and ARBs was lower than expected in this population," she said. "Our study suggests that successful strategies to prevent or slow the progression of nephropathy are needed and that these may effectively reduce the burden of disease."

Session moderator Leszek Czupryniak, MD, PhD, associate professor of diabetology and internal medicine at the University of Lodz in Poland, said other limitations of the study are the fact that the investigators had no information with which to correlate the drugs being used by individual patients with their outcomes, nor did they have information on concomitant diseases.

Nonetheless, he praised the study for following such a large cohort longitudinally according to the degree of albuminuria, obtaining data not previously available.

"What was interesting in the study is that a lot of people develop early kidney damage, but then very few of them progress to end-stage renal disease," Dr. Czupryniak said. "The more practical conclusion would be that, first of all, don't be afraid as a patient if your doctor [tells you] that you have microalbuminuria. . . . The second thing is — and it's an indirect implication of the study — that we do have measures to stop the kidney damage at that level."

He cited the fact that almost half the people with normal albumin excretion developed microalbuminuria, but only 6% progressed to macroalbuminuria, and a very tiny fraction (0.09%) developed end-stage renal disease. "We are able to maintain patients at an early level of kidney damage for years," he said.

"The study really shows that if [these patients had] normal albumin excretion, basically your kidneys work normally. You can progress within 7 or 8 years to microalbuminuria very easily. . . but people who already had macroalbuminuria, then the progression rate was very, very low," Dr. Czupryniak noted. Once albuminuria is detected, "definitely more aggressive prevention measures [should be] taken," adding that, "microalbuminuria is a reversible state." Drug, diet, and lifestyle interventions can help to limit the rate of nephropathy progression.

He strongly advises physicians to screen patients for albuminuria; it is not only a sign of kidney damage, it is a sign of generalized vasculopathy, including cardiovascular disease, that can be slowed or halted with aggressive pharmacologic treatment. But he cautioned that 1 measurement is not enough to make a diagnosis of microalbuminuria, and the test should be positive on at least 2 of 3 occasions, preferably at least 1 month apart.

"It's easy to develop microalbuminuria, but then it's also easy to stop it at this level," Dr. Czupryniak said.
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2010-10-18 22:01
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Progression of Diabetic Nephropathy Slowed With Early Detection of Albuminuria
2010EASD会讯——早期发现白蛋白尿有助于减缓糖尿病肾病进展
September 30, 2010 (Stockholm, Sweden) — A study of more than 11,000 adults with hypertension and type 2 diabetes, presented here at the European Association for the Study of Diabetes 46th Annual Meeting, showed that the lifetime risk for nephropathy and its progression might be greater than previously thought. In addition, results showed that the use of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) was not optimal in this population, indicating that there might be room for improvement in strategies to reduce the burden of disease.
2010年9月30日(瑞典斯德哥尔摩) - 一份对超过11,000名同时伴有高血压和2型糖尿病患者的研究,发表在第46届欧洲糖尿病学会年会的会讯(2010EASD会讯),该结果表明,终生肾病风险和肾病进展率高于既往预期。此外,结果表明,应用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻断剂(ARBs)不是被调查者的最优选择,表明为了减少疾病的负担,治疗策略可能存在改进的余地。

Epidemiologist Suma Vupputuri, PhD, MPH, from Kaiser Permanente Center for Health Research/Southeast in Atlanta, Georgia, said that estimates that one third of diabetic patients develop nephropathy are from a time when glycemic thresholds for the diagnosis of diabetes were higher than today, and before aggressive treatment was shown to reduce renal complications.
流行病学苏马Vupputuri,博士,公共卫生硕士,来自Kaiser Permanente的健康研究中心/佐治亚州亚特兰大市的东南。他说,以前,诊断为糖尿病的血糖阈值普遍比现在高,那时,糖尿病患者中大约三分之一发展到肾病,过去经过积极治疗的结果表明,可以减少肾脏并发症。

She said because nephropathy is a major cause of cardiovascular disease and end-stage renal disease, it is important to understand the progression from normal levels of albumin excretion to micro- and macroalbuminuria, and to define the risk factors associated with nephropathy progression.
她说,因为肾病是心血管疾病和终末期肾病的主要原因,所以重要的是要了解从白蛋白排泄正常水平发展到微量白蛋白尿和巨量白蛋白尿的过程,并确定与肾病进展相关的风险因素。

The researchers studied type 2 diabetes patients with hypertension (n = 11,562) who were 18 years or older and for whom there were urine albumin-to-creatinine ratios (UACR) documented in 2001, 2002, or 2003, and at least 1 additional UACR 3 to 8 years later.
研究人员研究了18岁以上并同时患高血压的2型糖尿病患者(n = 11562),并于2001年、2002年、2003年测定尿白蛋白/肌酐比值(UACR),并在其后3至8年至少随访1次 UACR。

The baseline stages of nephropathy were defined by the UACR: a ratio below 30 μg/mg was considered normal, from 30 to 299 μg/mg indicated microalbuminuria, and 300 μg/mg or above indicated macroalbuminuria. Progression was defined as the first UACR value recorded in a stage higher than that seen at the baseline. Patients were censored if they died or left the health plan.
肾病以UACR为标准分三期:尿蛋白正常(UACR<3.4 mg/mmol)、微量白蛋白尿(3.4~33.9 mg/mmol)和巨量白蛋白尿(≥33.9 mg/mmol)。“进展”是指当某一分期的患者UACR值第一次高于此期上线。患者如果去世或离开了健康计划,则被剔除。

Over 89 months of follow-up, the incidence of progression of nephropathy was highest for people with normal baseline UACRs, followed by patients with microalbuminuria, and then macroalbuminuria (94.6, 44.1, and 6.7 per 1000 patient-years, respectively).
超过89个月的随访,肾病进展的发生率如下:最高的为尿蛋白正常的患者,其次是微量白蛋白尿患者,然后是巨量白蛋白尿(每1000人年的发生率分别为94.6,44.1,6.7)

"Among patients with normal albumin at baseline, those who progressed to a higher stage of nephropathy were in general older, had a longer duration of diabetes, had higher mean blood pressures, and had higher HbA1cs [glycated haemoglobin]," Dr. Vupputuri said. The patients with microalbuminuria at baseline who progressed were more likely to be male, had longer durations of diabetes, had higher mean blood pressures, and had higher HbA1c levels. The macroalbuminuria group had risk factors similar to the microalbuminuria group, and had lower glomerular filtration rates (GFRs) and a diagnosis of cardiovascular disease or heart failure.
医生Vupputuri说:“白蛋白尿正常的患者中,肾病进展到更高阶段的病人有以下特点,1.普遍年纪较大,2.伴糖尿病且病程长,3.有较高的平均血压,4.较高水平糖化血红蛋白。微量白蛋白尿的患者中,肾病进展的病人,有以下特点:1.男性患病率高,2糖尿病且病程长,3.具有较高的平均血压,3.较高水平的糖化血红蛋白。巨量白蛋白尿的患者组,其肾病进展的危险因素与微量白蛋白尿组相似,其进展的患者肾小球滤过率较低(GFRs)且诊断有心血管疾病或心力衰竭。”

Across the stratified baseline cohorts, 78% to 91% of patients were receiving antihypertensive agents, and about half were receiving statins. Most were receiving antihyperglycemic drugs (range, 67% to 79%). The use of insulin went up and oral agents down with increasing nephropathy stage.
所有入组患者,78%至91%正在接受抗高血压药,约一半是接受他汀类药物。大多数人接受(范围在67%至79%之间)降血糖药物。伴随肾病的进展,胰岛素的使用上升及口服药物减少。

ACE inhibitor or ARB use ranged from 61% to 67% for all baseline groups, whether they progressed or not, with one notable exception. Of patients with baseline macroalbuminuria who progressed, ACE inhibitor or ARB use was only 38%.
ACEI/ARB的使用率处于61%~67%之间。不管是否进展,有一个明显的异常。巨量白蛋白尿组肾病进展的患者中,使用ACEI或ARB的只有38%。

From the 3 Cox regression models that identified risk factors for time to progression for each baseline cohort, it emerged that ACE inhibitor or ARB use was not a significant factor for patients with normal albumin levels ormicroalbuminuria at baseline.
从3 Cox回归模型,此模型为每组患者肾病进展的风险因素确定了时间,发现ACEI/ARB的使用不是正常白蛋白尿及微量蛋白尿患者的重要因素。

However, for patients with baseline macroalbuminuria, the use of these drugs conferred a multivariate hazard ratio (HR) of 0.53 (95% confidence interval [CI], 0.29 - 0.95), meaning their use reduced the risk for progression by 47%. Similarly, age conferred a 21% benefit per 5 years (HR, 0.79 per 5 years; 95% CI, 0.66 - 0.95), as did estimated GFR, with a 65% risk reduction for every increase of 10 mL/min per 1.73 m2 (HR, 0.35; 95% CI, 0.27 - 0.48).
然而,对巨量白蛋白尿患者使用这些药物的危害赋予多元风险比(HR)为0.53(95%信心区间[CI],0.29 - 0.95),这意味着它们的使用减少了47%的恶化风险。同样,年龄赋予每个五年21%受益(HR为0.79/5年; 95%CI,0.66 - 0.95),同样,GFR大约每增加10 mL/(min×1.73 m2),风险降低65%(HR为0.35; 95%CI为0.27 - 0.48)。

Dr. Vupputuri summarized by saying that of the entire baseline cohort, 41% had prevalent micro- or macroalbuminuria, and 68% with a normal starting level developed micro- or macroalbuminuria.
Vupputuri博士总结说,整个被随访患者中,41%的人普遍存在微量白蛋白尿或巨量白蛋白尿;尿蛋白正常者的肾病进展发生率较高,在随访结束时有68%的患者出现微量或巨量白蛋白尿。

Predictors of progression of nephropathy included age, race (being African American was somewhat protective), diabetes duration, systolic and diastolic blood pressure, HbA1c level, body mass index, estimated GFR, ACE inhibitor/ARB use, and cardiovascular disease.
肾病进展的预测因子包括年龄,种族(非裔美国人进展有点慢),糖尿病病程,收缩压和舒张压,糖化血红蛋白水平,体重指数,估计肾小球滤过率,ACEI/ARB的使用和心血管疾病。

A limitation of the study is its possible lack of generalizability; it was restricted to patients with diabetes, hypertension, and health insurance who had multiple determinations of UACR. Furthermore, estimates of risk for progression could have been biased by patients who died before their nephropathy might have progressed. Finally, individual variation in albumin excretion and serum creatinine production could have influenced the results.
这项研究的局限是可能缺乏一般性;它仅限于糖尿病,高血压患者和曾多次测定UACR(尿白蛋白肌酐比)的健康保险患者。此外,对进展的风险估计可能有偏差,因为有些病人去世时肾病可能已经进展。最后,白蛋白排泄和血肌酐产生的个体差异可能会影响结果。

Dr. Vupputuri concluded that the progression of diabetic nephropathy found here was higher than previously reported. "The use of ACE [inhibitors] and ARBs was lower than expected in this population," she said. "Our study suggests that successful strategies to prevent or slow the progression of nephropathy are needed and that these may effectively reduce the burden of disease."
Vupputuri博士得出结论认为,这项研究中,糖尿病肾病的进展率高于以往的报告。她说, “入组患者中,ACEI和ARB药物的使用低于预期,我们的研究表明,阻止或延缓肾病进展的成功战略是必要的,这样可以有效地减少疾病的负担。”

Session moderator Leszek Czupryniak, MD, PhD, associate professor of diabetology and internal medicine at the University of Lodz in Poland, said other limitations of the study are the fact that the investigators had no information with which to correlate the drugs being used by individual patients with their outcomes, nor did they have information on concomitant diseases.
会议主持人Leszek Czupryniak(医师,博士,波兰罗兹大学糖尿病和内科副教授)表示,这项研究的其他局限在于调查人员既没有患者使用的、与结果息息相关的药物的信息,也没有伴随疾病的信息。

Nonetheless, he praised the study for following such a large cohort longitudinally according to the degree of albuminuria, obtaining data not previously available.
不过,他赞扬了这项研究获取以前没有利用的数据,根据蛋白尿程度纵向分期分组的大样本研究。

"What was interesting in the study is that a lot of people develop early kidney damage, but then very few of them progress to end-stage renal disease," Dr. Czupryniak said. "The more practical conclusion would be that, first of all, don't be afraid as a patient if your doctor [tells you] that you have microalbuminuria. . . . The second thing is — and it's an indirect implication of the study — that we do have measures to stop the kidney damage at that level."
“研究中有趣的是,很多人都发展为早期肾损害,但后来很少有人进展到终末期肾脏疾病,”博士Czupryniak说。 “
“更实际的结论是,首先,作为一个病人,如果医生告诉你有微量白蛋白尿,你不要害怕;第二点——它是这个研究的间接意义——早期肾损害阶段,我们确实有措施阻止其进展。

He cited the fact that almost half the people with normal albumin excretion developed microalbuminuria, but only 6% progressed to macroalbuminuria, and a very tiny fraction (0.09%) developed end-stage renal disease. "We are able to maintain patients at an early level of kidney damage for years," he said.
他举例说,事实上,几乎一半的正常蛋白尿病人进展到微量白蛋白尿,但只有6%,进展到大量蛋白尿,以及一个很小的比例(0.09%)进展到终末期肾病。 “我们能够使患者多年维持在早期肾损害中。”他说。

"The study really shows that if [these patients had] normal albumin excretion, basically your kidneys work normally. You can progress within 7 or 8 years to microalbuminuria very easily. . . but people who already had macroalbuminuria, then the progression rate was very, very low," Dr. Czupryniak noted. Once albuminuria is detected, "definitely more aggressive prevention measures [should be] taken," adding that, "microalbuminuria is a reversible state." Drug, diet, and lifestyle interventions can help to limit the rate of nephropathy progression.,
“这项研究表明,如果这些患者真的白蛋白排泄正常,基本上肾脏正常工作。您很容易在7或8年内进展到微量白蛋白尿……但是已经有巨量蛋白尿的患者,则进展率极低”博士Czupryniak指出。“一旦检测到蛋白尿,肯定应采取更积极的预防措施,”他补充说,“微量蛋白尿是一个可逆的状态。”药物,饮食和生活方式干预可以有助于降低肾病进展率。

He strongly advises physicians to screen patients for albuminuria; it is not only a sign of kidney damage, it is a sign of generalized vasculopathy, including cardiovascular disease, that can be slowed or halted with aggressive pharmacologic treatment. But he cautioned that 1 measurement is not enough to make a diagnosis of microalbuminuria, and the test should be positive on at least 2 of 3 occasions, preferably at least 1 month apart.
他强烈建议医生检测患者的蛋白尿,蛋白尿不仅是肾损害的标志,也是广义血管病变,包括心血管疾病的标志,通过积极的药物治疗有助于减缓或阻断糖尿病肾病的进展。但他警告说,1次测量对于做微量白蛋白尿的诊断是不够的,测试应该是积极的,至少2--3次,最好是至少隔一个月。

"It's easy to develop microalbuminuria, but then it's also easy to stop it at this level," Dr. Czupryniak said.
“人们很容易进展到微量白蛋白尿,但是也很容易停留在这个水平上,”博士Czupryniak说。
2010-10-18 22:03
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  • • 王雪强教授康复团队招聘博士后
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Progression of Diabetic Nephropathy Slowed With Early Detection of Albuminuria

September 30, 2010 (Stockholm, Sweden) — A study of more than 11,000 adults with hypertension and type 2 diabetes, presented here at the European Association for the Study of Diabetes 46th Annual Meeting, showed that the lifetime risk for nephropathy and its progression might be greater than previously thought. In addition, results showed that the use of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) was not optimal in this population, indicating that there might be room for improvement in strategies to reduce the burden of disease.

Epidemiologist Suma Vupputuri, PhD, MPH, from Kaiser Permanente Center for Health Research/Southeast in Atlanta, Georgia, said that estimates that one third of diabetic patients develop nephropathy are from a time when glycemic thresholds for the diagnosis of diabetes were higher than today, and before aggressive treatment was shown to reduce renal complications.

She said because nephropathy is a major cause of cardiovascular disease and end-stage renal disease, it is important to understand the progression from normal levels of albumin excretion to micro- and macroalbuminuria, and to define the risk factors associated with nephropathy progression.

The researchers studied type 2 diabetes patients with hypertension (n = 11,562) who were 18 years or older and for whom there were urine albumin-to-creatinine ratios (UACR) documented in 2001, 2002, or 2003, and at least 1 additional UACR 3 to 8 years later.

The baseline stages of nephropathy were defined by the UACR: a ratio below 30 μg/mg was considered normal, from 30 to 299 μg/mg indicated microalbuminuria, and 300 μg/mg or above indicated macroalbuminuria. Progression was defined as the first UACR value recorded in a stage higher than that seen at the baseline. Patients were censored if they died or left the health plan.

Over 89 months of follow-up, the incidence of progression of nephropathy was highest for people with normal baseline UACRs, followed by patients with microalbuminuria, and then macroalbuminuria (94.6, 44.1, and 6.7 per 1000 patient-years, respectively).

"Among patients with normal albumin at baseline, those who progressed to a higher stage of nephropathy were in general older, had a longer duration of diabetes, had higher mean blood pressures, and had higher HbA1cs [glycated haemoglobin]," Dr. Vupputuri said. The patients with microalbuminuria at baseline who progressed were more likely to be male, had longer durations of diabetes, had higher mean blood pressures, and had higher HbA1c levels. The macroalbuminuria group had risk factors similar to the microalbuminuria group, and had lower glomerular filtration rates (GFRs) and a diagnosis of cardiovascular disease or heart failure.

Across the stratified baseline cohorts, 78% to 91% of patients were receiving antihypertensive agents, and about half were receiving statins. Most were receiving antihyperglycemic drugs (range, 67% to 79%). The use of insulin went up and oral agents down with increasing nephropathy stage.

ACE inhibitor or ARB use ranged from 61% to 67% for all baseline groups, whether they progressed or not, with one notable exception. Of patients with baseline macroalbuminuria who progressed, ACE inhibitor or ARB use was only 38%.

From the 3 Cox regression models that identified risk factors for time to progression for each baseline cohort, it emerged that ACE inhibitor or ARB use was not a significant factor for patients with normal albumin levels or microalbuminuria at baseline.

However, for patients with baseline macroalbuminuria, the use of these drugs conferred a multivariate hazard ratio (HR) of 0.53 (95% confidence interval [CI], 0.29 - 0.95), meaning their use reduced the risk for progression by 47%. Similarly, age conferred a 21% benefit per 5 years (HR, 0.79 per 5 years; 95% CI, 0.66 - 0.95), as did estimated GFR, with a 65% risk reduction for every increase of 10 mL/min per 1.73 m2 (HR, 0.35; 95% CI, 0.27 - 0.48).

Dr. Vupputuri summarized by saying that of the entire baseline cohort, 41% had prevalent micro- or macroalbuminuria, and 68% with a normal starting level developed micro- or macroalbuminuria.

Predictors of progression of nephropathy included age, race (being African American was somewhat protective), diabetes duration, systolic and diastolic blood pressure, HbA1c level, body mass index, estimated GFR, ACE inhibitor/ARB use, and cardiovascular disease.

A limitation of the study is its possible lack of generalizability; it was restricted to patients with diabetes, hypertension, and health insurance who had multiple determinations of UACR. Furthermore, estimates of risk for progression could have been biased by patients who died before their nephropathy might have progressed. Finally, individual variation in albumin excretion and serum creatinine production could have influenced the results.

Dr. Vupputuri concluded that the progression of diabetic nephropathy found here was higher than previously reported. "The use of ACE [inhibitors] and ARBs was lower than expected in this population," she said. "Our study suggests that successful strategies to prevent or slow the progression of nephropathy are needed and that these may effectively reduce the burden of disease."

Session moderator Leszek Czupryniak, MD, PhD, associate professor of diabetology and internal medicine at the University of Lodz in Poland, said other limitations of the study are the fact that the investigators had no information with which to correlate the drugs being used by individual patients with their outcomes, nor did they have information on concomitant diseases.

Nonetheless, he praised the study for following such a large cohort longitudinally according to the degree of albuminuria, obtaining data not previously available.

"What was interesting in the study is that a lot of people develop early kidney damage, but then very few of them progress to end-stage renal disease," Dr. Czupryniak said. "The more practical conclusion would be that, first of all, don't be afraid as a patient if your doctor [tells you] that you have microalbuminuria. . . . The second thing is — and it's an indirect implication of the study — that we do have measures to stop the kidney damage at that level."

He cited the fact that almost half the people with normal albumin excretion developed microalbuminuria, but only 6% progressed to macroalbuminuria, and a very tiny fraction (0.09%) developed end-stage renal disease. "We are able to maintain patients at an early level of kidney damage for years," he said.

"The study really shows that if [these patients had] normal albumin excretion, basically your kidneys work normally. You can progress within 7 or 8 years to microalbuminuria very easily. . . but people who already had macroalbuminuria, then the progression rate was very, very low," Dr. Czupryniak noted. Once albuminuria is detected, "definitely more aggressive prevention measures [should be] taken," adding that, "microalbuminuria is a reversible state." Drug, diet, and lifestyle interventions can help to limit the rate of nephropathy progression.

He strongly advises physicians to screen patients for albuminuria; it is not only a sign of kidney damage, it is a sign of generalized vasculopathy, including cardiovascular disease, that can be slowed or halted with aggressive pharmacologic treatment. But he cautioned that 1 measurement is not enough to make a diagnosis of microalbuminuria, and the test should be positive on at least 2 of 3 occasions, preferably at least 1 month apart.

"It's easy to develop microalbuminuria, but then it's also easy to stop it at this level," Dr. Czupryniak said.
请问 有这份报道的 相关文献吗? 谢谢····
2012-03-08 15:30
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