Nephrology Dialysis Transplantation, Vol 12, Issue 9 1890-1899, Copyright © 1997 by Oxford University Press
P Sawickifor the Diabetes Treatment and T Programmes Working Group
Objectives. We investigated the effect of achieved
continuos tight blood pressure control and intensified insulin therapy on
the rate of progression of renal failure in patients with overt diabetic
nephropathy and already impaired renal function. Design and
setting. Prospective, randomized, multicentre, follow-up study.
Patients and interventions. From a screened group of
the 66 hypertensive type 1 diabetic patients (IDDM) with overt diabetic
nephropathy and reduced glomerular filtration rate who participated in two
intensified treatment programmes, 39 patients fulfilled the study inclusion
criteria and were enrolled into the 2-year follow-up period. The choice of
antihypertensive drugs was based on a randomized allocation to open
antihypertensive treatments starting with felodipine, metoprolol, or
ramipril. Outcome and measures. Progression of renal
failure was assessed by measurement of glomerular filtration rate (GFR) by
inulin clearance every 6 months. Main results. During
the study period mean HbAlc was 8.1±1.6% and the office blood
pressure 143±14/88±8 mmHg. The change in GFRinulin
(mean and 95% CI) was +1.9 (-2.2 +6.1) ml/min/year. GFR improved in 51%,
deteriorated in 39%, and remained stable in 10% of the patients.
Conclusions. This study shows that stabilization of
glomerular filtration rate, as assessed by inulin clearance, is possible in
patients with overt diabetic nephropathy who reach the goals of intensified
antihypertensive treatment even if kidney function is already impaired.
Keywords: diabetic nephropathy; hypertension;
antihypertensive treatment; glycaemic control
ORIGINAL ARTICLES
Stabilization of glomerular filtration rate over 2 years in patients with diabetic nephropathy under intensified therapy regimes
Department of Metabolic Diseases and Nutrition, Heinrich-Heine University, PO Box 10 10 07; D-40001 Dusseldorf, Germany; Corresponding author
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