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Renoprotection Not Sufficient for Patients With Diabetes

Type 1 diabetes and kidney dysfunction pose high mortality risk despite renoprotective treatment

FRIDAY, Feb. 25 (HealthDay News) -- Patients with type 1 diabetes and macroalbuminuria remain at high risk for developing end-stage renal disease (ESRD) despite the increased use of renoprotective treatment, according to a study published online Feb. 25 in the Journal of the American Society of Nephrology.

Elizabeth T. Rosolowsky, M.D., of the Joslin Diabetes Center in Boston, and colleagues examined the risk of ESRD in 423 white patients with type 1 diabetes and macroalbuminuria between 1991 and 2004. The researchers examined the predictors of ESRD and the patients' mortality rates pre- and post-ESRD. Ninety-eight percent of the cohort was followed up until 2008.

The researchers found that 172 patients developed ESRD over the duration of the study. They also found that 29 patients without ESRD died; most of these patients were aged 36 to 52 and had endured diabetes between 21 and 37 years. Renoprotective treatment use increased from 56 to 82 percent during the 15 years of follow-up, and a significant improvement was seen in patients' blood pressures and lipid levels over this time; however, there was little change in the risk of ESRD and pre-ESRD death. The cumulative mortality risk for ESRD was 52 percent, and 11 percent for pre-ESRD. Seventy post-ESRD deaths occurred during the study, with similar mortality rates during the 1990s and 2000s. Pre-emptive kidney transplants reduced mortality.

"Despite the widespread adoption of renoprotective treatment, patients with type 1 diabetes and macroalbuminuria remain at high risk for ESRD, suggesting that more effective therapies are desperately needed," the authors write.

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