YEAR IN REVIEW DIABETIC NEPHROPATHY IN 2014

Improved cardiorenal prognosis in diabetic nephropathy Hans-Henrik Parving and Peter Rossing

In 2014, key studies in the field of diabetic nephropathy highlighted the importance of albuminuria as a predictor of cardiovascular risk and showed that the incidence of renal and cardiovascular complications is decreasing. Promising efficacy data were obtained with atrasentan, whereas a trial of bardoxolone methyl led to safety concerns. Parving, H.‑H. & Rossing, P. Nat. Rev. Nephrol. advance online publication 9 December 2014; doi:10.1038/nrneph.2014.238

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Persistent albuminuria is a hallmark of dia­ betic nephropathy, a condition characterized by progressively increasing blood pressure, decreasing glomerular filtration rate (GFR) and a high risk of fatal and nonfatal cardio­ vascular events. Key studies published in 2014 have furthered our understanding of cardiorenal risk—and how it might be reduced—in patients with this disease. Baseline albuminuria >300 mg per 24 h (albumin:creatinine ratio [ACR] 300 mg/g), initial change in level of albuminuria and residual albuminuria during renopro­ tective treatment are highly predictive of renal and cardiovascular outcomes in patients with proteinuric diabetic kidney disease.1 However, the clinical importance of urinary albumin excretion within the normal and microalbuminuric ranges is less clear. In 2014, an analysis of data from

the ONTARGET and TRANSCEND studies provided new insight into this area.2 The study included 22,984 patients with high cardiovascular risk, 32.9% of whom had type 2 diabetes mellitus (T2DM). At base­ line, 85.2% of participants had normo­ albuminuria and the remaining 14.8% had microalbuminuria (ACR 30–299 mg/g) based on a single first-morning spot urine sample. Baseline albuminuria was strongly associated with all-cause and cardiovas­ cular mortality as well as with combined cardiovascular and renal end points (all P 

Diabetic nephropathy in 2014: improved cardiorenal prognosis in diabetic nephropathy.

In 2014, key studies in the field of diabetic nephropathy highlighted the importance of albuminuria as a predictor of cardiovascular risk and showed t...
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