培训课件-糖尿病肾病基础研究及诊断治疗的某些进展.ppt

* * * * * * * * Improved survival in patients obtaining remission of nephrotic range albuminuria in diabetic nephropathy. P. Hovind1, L. Tarnow1,?. Rossing1, B. Carstensen1, H.-H. Parving12; ^teno Diabetes Center, Gentofte, Denmark, faculty of Health Science, University of Aarhus, Denmark. Background and Aims: To evaluate the impact of remission of nephrotic range albuminuria (NRA) on end stage renal disease (ESRD) and mortality in type 1 diabetic patients with diabetic nephropathy we performed a prospective cohort study. Materials and Methods: All type 1 diabetic patients with NRA (n=126), who had yearly GFR (51Cr-EDTA plasma clearance) measurement carried out for at least 3 years, were followed from onset of NRA until death or 2000. Nephrotic range albuminuria was defined as persistent albuminuria above 2.5 g/24h, and occurred in 91 men and 35 women, age (mean (SD)) 34 (8) years, duration of diabetes 22 (8) years, follow up time from onset of NRA (median (range)) 8.7 (3.0-20.9) years. All patients but one received antihypertensive treatment. Remission of NRA was defined as sustained albuminuria 0.6 g/24h for at least one year. Remission was induced in 28 patients (22%), 21 predominantly treated with ACE inhibitors, 7 with non-ACE inhibitors. The remission lasted 3.6 (1.0-18.1) years. Results: At the end of follow up, the composite endpoint of ESRD or death was reached in 21 % in the remission group (2 ESRD and 4 dead) and 59 % in the no remission group (24 ESRD and 34 dead). A Cox proportional hazard regression analysis with sex and age at onset of NRA as fixed covariates and remission as time dependent covariate was performed: obtaining remission was associated with a lower risk of ESRD or death, relative risk (95 % CI) 0.35 (0.16 to 0.80), p0.012, whereas older age at onset of NRA (per 10 years increase) was associated with higher risk of reaching the endpoint, 1.61 (1.20 to 2.16), p0.001. As previously shown, the rate of decline in GFR during the whole follow u