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New research suggests that attempts to normalize blood pressure and cholesterol may have long-term negative effects on kidney health in adults with type 2 diabetes who are at high risk for cardiovascular disease. The results will be published in a future issue of Clinical Journal of the American Society of Nephrology (CJASN) and will be presented at ASN Kidney Week 2018.
Type 2 diabetes significantly increases the risk of cardiovascular disease and chronic kidney disease. Therefore, it is particularly important to protect the heart and kidney health of patients with type 2 diabetes. In these patients, aggressive control of blood glucose, blood pressure, and cholesterol has resulted in contradictory, short-term effects on patients with type 2 diabetes. kidney health. To determine the long-term kidney effects of these interventions, Amy K. Mottl, MD (University of North Carolina Kidney Center), Timothy E. Craven, MSPH (Wake Forest School of Medicine) and their colleagues reviewed information relating to more than 10,000 participants at ACCORDION, which is an extension phase of the ACCORD trial, a multifactorial intervention study in people with type 2 diabetes mellitus and with a high risk of cardiovascular disease.
The team found that intensive blood glucose control for normal mean blood glucose (hemoglobin target A1c <6%) reduced the risk of macroalbuminuria (a large amount of protein excreted in the urine) on a mean follow-up of blood glucose levels. 7.7 years. had no impact on more significant renal outcomes such as doubling serum creatinine (a marker of worsening renal function) or the need for dialysis or transplantation. Intensive control of blood pressure or the use of fenofibrate to lower cholesterol increased the risk of doubling serum creatinine, but did not increase the need for dialysis or transplantation.
"These findings, along with those from the first study, which showed no benefit from interventions on heart attacks and strokes, provide evidence against aggressive targets for blood glucose, blood pressure and blood pressure. use of fenfibrate in adults with type 2 diabetes at high risk of cardiovascular disease events, "said Dr. Mottl.
An accompanying editorial challenges some of the conclusions. "In our opinion, the observed results regarding the doubling of serum creatinine do not suggest kidney damage, but rather are likely to reflect the limitations of the low number of available creatinine measurements," the authors wrote. "We believe the data suggests a potential benefit for ESKD [end-stage kidney disease] with intensive blood glucose control and are inconclusive for intensive blood pressure control and fibrate use, given the extended confidence intervals for more reliable results of the DSPK. "
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Material provided by American Society of Nephrology. Note: Content can be changed for style and length.
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