MO479BLOOD PRESSURE CONTROL AND OUTCOMES IN DIABETIC RENAL DISEASE : EVIDENCE FROM A TUNISIAN COHORT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boukhtioua Mariem ◽  
Mami Ikram ◽  
Tlili Syrine ◽  
Ghabi Hiba ◽  
Hela Jbali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Urinary Albumin Excretion ◽  
Pressure Control ◽  
Urinary Albumin ◽  
Patients With Diabetes ◽  
Group B ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Diabetic nephropathy (DN) is associated with a high incidence of cardiovascular morbidity and mortality. The relationship between hypertension and diabetic nephropathy is complex and blood pressure (BP) control is an important management strategy in the prevention of its onset and progression .The aim of this study was to determine whether blood pressure control delays the progression of DN and prevents macrovascular complications in patients with diabetes mellitus. Method Hypertension guidelines advocate treating systolic blood pressure to less than 130 mm Hg and diastolic blood pressure to less than 80 mmHg for patients with diabetes mellitus and overt nephropathy.The relationship between blood pressure and progression of nephropathy was studied in 120 diabetic and hypertensive patients with established diabetic nephropathy. We divided hypertensive patients with stage 1 to 3 CKD already treated with antihypertensive therapy into 2 groups: those with BP < 130/80 mmHg were designated as Group A (n=66) and those with BP> 130/80 as Group B (n=54). Serum creatinine level as well as urinary albumin excretion were measured at 3 months,6 months, one year,2 years and at last visit during follow-up.The GFR was calculated using the Modification of diet in renal disease formula.The kidney disease outcome was defined as time to end-stage renal disease. The cardiovascular outcome was defined as time to myocardial infarction, stroke,ischemic stroke, hospitalization for heart failure, or revascularization. Results During the mean follow up period of 33,8 ± 11,7 months, the primary end point of end-stage renal disease occured in 9 patients (7 patients in Group B versus 2 patients in groupe A) while 11 hypertensive patient experienced a cardiovascular event.  The decline rate in GFR was significantly more important in groupe B (p<0,05). However, little difference existed between the two groups in urinary albumin excretion. Blood pressure control was not associated with improved cardiovascular outcomes when comparing the two groups. Conclusion The results of our study indicate that an uncontrolled hypertension is associated with a rapid progression of kidney impairment in diabetic patients with overt nephropathy but no relationship with the incidence of cradiovascular events was seen in our population.

scholarly journals Inflammatory Cytokines in Diabetic Nephropathy

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Javier Donate-Correa ◽  
Ernesto Martín-Núñez ◽  
Mercedes Muros-de-Fuentes ◽  
Carmen Mora-Fernández ◽  
Juan F. Navarro-González
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Diabetic Complication ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Molecular Events ◽  
Patients With Diabetes ◽  
Inflammatory Processes ◽  
Stage Renal Disease ◽  
End Stage

Probably, the most paradigmatic example of diabetic complication is diabetic nephropathy, which is the largest single cause of end-stage renal disease and a medical catastrophe of worldwide dimensions. Metabolic and hemodynamic alterations have been considered as the classical factors involved in the development of renal injury in patients with diabetes mellitus. However, the exact pathogenic mechanisms and the molecular events of diabetic nephropathy remain incompletely understood. Nowadays, there are convincing data that relate the diabetes inflammatory component with the development of renal disease. This review is focused on the inflammatory processes that develop diabetic nephropathy and on the new therapeutic approaches with anti-inflammatory effects for the treatment of chronic kidney disease in the setting of diabetic nephropathy.

Peritoneal Dialysis in Patients with Diabetes: Are the Benefits Greater than the Disadvantages?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 190-195 ◽  
Author(s):  
Satoru Kuriyama
Keyword(s):  
Diabetic Nephropathy ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Dialysis Modality ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Selection Of

Diabetic nephropathy has been increasing in prevalence in recent years, and it is now the dominant cause of end-stage renal disease (ESRD) worldwide. Because diabetes is frequently associated with multiple complications, nephrologists must be alert to the selection of dialysis modality so as to reduce the accompanying risks. The present review addresses whether the benefits of peritoneal dialysis are greater than its disadvantages in diabetic patients. The answer is quite positive: for most diabetic patients, peritoneal dialysis offers multiple benefits.

Diabetic renal disease

2018 ◽  
Author(s):  
William G. Herrington ◽  
Aron Chakera ◽  
Christopher A. O’Callaghan
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Poor Glycaemic Control ◽  
Glycation End Products ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy is kidney damage occurring as a result of diabetes mellitus. Overt diabetic nephropathy is defined as proteinuria greater than 0.5 g/day. Diabetic nephropathy has a complicated pathogenesis including glomerular hypertension with hyperfiltration and advanced glycation end products. Poor glycaemic control is associated with progression to microalbuminuria and overt diabetic nephropathy. The lifetime risk is fairly equivalent for type 1 and type 2 diabetes mellitus. Early disease is usually asymptomatic. Hyperglycaemia causes an osmotic diuresis and, thus, diabetes can present with polyuria. Hypertension develops with microalbuminuria; oedema indicates abnormal sodium and water retention and, occasionally, the development of nephrotic syndrome. Patients with diabetes, perhaps due to accompanying cardiac disease, are particularly susceptible to fluid overload and uraemic symptoms. End-stage renal disease can occur as early as when the estimated glomerular filtration rate is 15 ml/min 1.73 m−2.

scholarly journals Diabetic Nephropathy: Challenges in Pathogenesis, Diagnosis, and Treatment

2021 ◽  
Vol 2021 ◽  
pp. 1-17
Author(s):  
Nur Samsu
Keyword(s):  
Blood Pressure ◽  
Diabetic Nephropathy ◽  
Renin Angiotensin System ◽  
Pressure Control ◽  
Therapeutic Interventions ◽  
Diagnosis And Treatment ◽  
Chronic Hyperglycemia ◽  
Classic Pattern ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Chronic hyperglycemia and high blood pressure are the main risk factors for the development of DN. In general, screening for microalbuminuria should be performed annually, starting 5 years after diagnosis in type 1 diabetes and at diagnosis and annually thereafter in type 2 diabetes. Standard therapy is blood glucose and blood pressure control using the renin-angiotensin system blockade, targeting A 1 c < 7 % , and <130/80 mmHg. Regression of albuminuria remains an important therapeutic goal. However, there are problems in diagnosis and treatment of nonproteinuric DN (NP-DN), which does not follow the classic pattern of DN. In fact, the prevalence of DN continues to increase, and additional therapy is needed to prevent or ameliorate the condition. In addition to conventional therapies, vitamin D receptor activators, incretin-related drugs, and therapies that target inflammation may also be promising for the prevention of DN progression. This review focuses on the role of inflammation and oxidative stress in the pathogenesis of DN, approaches to diagnosis in classic and NP-DN, and current and emerging therapeutic interventions.

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