Evidence-based Clinical Treatment of Diabetic Nephropathy with Albuminuria_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Xiaolan , MENG Zhangmin , ZHENG Yuxia , WANG shuang

Department of Gerontology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Diabetic nephropathy; Albuminuria; Angiotensin receptor antagonists; Evidence-based treatment

DOI：

10.7507/1672-2531.20080046

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective　 To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria.
Methods　 Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ willingness was also taken into consideration in the decision-making treatment
Results　 Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative.
Conclusion　 The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.

Citation： CHEN Xiaolan,MENG Zhangmin,ZHENG Yuxia,WANG shuang. Evidence-based Clinical Treatment of Diabetic Nephropathy with Albuminuria. Chinese Journal of Evidence-Based Medicine, 2008, 08(3): 210-213. doi: 10.7507/1672-2531.20080046 Copy

1.	Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group. Circulation, 2002, 106(14): e9037- e9038.
2.	Pitt B, Segal R, Martinez FA, et al. Randomized trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in The Elderly Study, ELITE). Lancet, 1997, 349(9054): 747-752.
3.	de Zeeuw D, Remuzzi G, Parving HH, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation, 2004, 110(8): 921-927.
4.	Parving HH, Lehnert H, Jens BM, et al. for the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. N Engl J Med, 2001, 345: 851.
5.	Viberti G, Nigel M. Wheeldon for the MicroAlbuminuria Reduction With VALsartan (MARVAL) Study Investigators Microalbuminuria Reduction With Valsartan in Patients With Type 2 Diabetes Mellitus: A Blood Pressure–Independent Effect. Circulation, 2002,106: 672-678.
6.	Weber MA, Julius S, Kjeldsen SE, et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet, 2004, 363(9426): 2049-2051.
7.	Mogensen CE, Neldan S, Tikkanen I, et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ, 2000, 321: 1440-1444.
8.	Hollenberg NK, Parving HH, Viberti G, et al. Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. J Hypertens, 2007, 25(9): 1921-1926.
9.	UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascylar complications in type 2 diabetes: UKPDS 38. BMJ, 1998, 317(7160): 703-713.
10.	Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: Cochrone Library. 2006, Issue 2.
11.	Lovell HG. Angiotension converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: Cochrone library. 2005, Issue 3.
12.	Parving HH, Lehnert H, Jens BM, et al. for the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. N Engl J Med, 2001, 345: 870.
13.	Eijkelkamp WB, Zhang Z, Remuzzi G, et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J Am Soc Nephrol, 2007, 18(5): 1540-1546.
14.	Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet, 2000, 355: 253-259.
15.	Sasso FC, Carbonara O, Persico M, et al. Irbesartan reduces the albumin excretion rate in microalbuminuric type 2 diabetic patients independently of hypertension: a randomized double-blind placebo-controlled crossover study. Diabetes Care, 2002, 25(11): 1909-1913.
16.	Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascularoutcomes in patients with type 2 diabetes and nephropathy. N Engl J Med, 2001, 345: 861-869.
17.	Kasiske BL, Kalil RS, Ma JZ, et al. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis.Ann Intern Med, 1993, 118(2): 129-138.
18.	Strippoli GF, Craig MC, Schena FP, et al. Role of blood pressure targets and specific antihypertensive agents used to prevent diabetic nephropathy and delay its progression. J Am Soc Nephrol, 2006, 17(4 Suppl 2): S153-155.
19.	American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2007, 30: S4-41S.

1. Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group. Circulation, 2002, 106(14): e9037- e9038.
2. Pitt B, Segal R, Martinez FA, et al. Randomized trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in The Elderly Study, ELITE). Lancet, 1997, 349(9054): 747-752.
3. de Zeeuw D, Remuzzi G, Parving HH, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation, 2004, 110(8): 921-927.
4. Parving HH, Lehnert H, Jens BM, et al. for the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. N Engl J Med, 2001, 345: 851.
5. Viberti G, Nigel M. Wheeldon for the MicroAlbuminuria Reduction With VALsartan (MARVAL) Study Investigators Microalbuminuria Reduction With Valsartan in Patients With Type 2 Diabetes Mellitus: A Blood Pressure–Independent Effect. Circulation, 2002,106: 672-678.
6. Weber MA, Julius S, Kjeldsen SE, et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet, 2004, 363(9426): 2049-2051.
7. Mogensen CE, Neldan S, Tikkanen I, et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ, 2000, 321: 1440-1444.
8. Hollenberg NK, Parving HH, Viberti G, et al. Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. J Hypertens, 2007, 25(9): 1921-1926.
9. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascylar complications in type 2 diabetes: UKPDS 38. BMJ, 1998, 317(7160): 703-713.
10. Strippoli GFM, Craig M, Craig JC. Antihypertensive agents for preventing diabetic kidney disease. In: Cochrone Library. 2006, Issue 2.
11. Lovell HG. Angiotension converting enzyme inhibitors in normotensive diabetic patients with microalbuminuria. In: Cochrone library. 2005, Issue 3.
12. Parving HH, Lehnert H, Jens BM, et al. for the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes. N Engl J Med, 2001, 345: 870.
13. Eijkelkamp WB, Zhang Z, Remuzzi G, et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J Am Soc Nephrol, 2007, 18(5): 1540-1546.
14. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet, 2000, 355: 253-259.
15. Sasso FC, Carbonara O, Persico M, et al. Irbesartan reduces the albumin excretion rate in microalbuminuric type 2 diabetic patients independently of hypertension: a randomized double-blind placebo-controlled crossover study. Diabetes Care, 2002, 25(11): 1909-1913.
16. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascularoutcomes in patients with type 2 diabetes and nephropathy. N Engl J Med, 2001, 345: 861-869.
17. Kasiske BL, Kalil RS, Ma JZ, et al. Effect of antihypertensive therapy on the kidney in patients with diabetes: a meta-regression analysis.Ann Intern Med, 1993, 118(2): 129-138.
18. Strippoli GF, Craig MC, Schena FP, et al. Role of blood pressure targets and specific antihypertensive agents used to prevent diabetic nephropathy and delay its progression. J Am Soc Nephrol, 2006, 17(4 Suppl 2): S153-155.
19. American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care, 2007, 30: S4-41S.

Chinese Journal of Evidence-Based Medicine

Evidence-based Clinical Treatment of Diabetic Nephropathy with Albuminuria

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content