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Renin–angiotensin–aldosterone system blockade and urinary albumin excretion in community‐based patients with Type 2 diabetes: The Fremantle Diabetes Study
Author(s) -
Fegan P. G.,
Davis W. A.,
Kamber N.,
Sivakumar S.,
Beilby J.,
Davis T. M. E.
Publication year - 2011
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2011.03230.x
Subject(s) - medicine , microalbuminuria , endocrinology , diabetes mellitus , creatinine , aldosterone , ace inhibitor , type 2 diabetes , angiotensin converting enzyme , albuminuria , urology , blood pressure
Diabet. Med. 28, 849–855 (2011) Abstract Aims To determine whether the reduction in urinary albumin excretion through renin–angiotensin–aldosterone system blockade found in intervention trials extends to community‐based patients with Type 2 diabetes. Methods We analysed data from 302 participants in the longitudinal observational Fremantle Diabetes Study who commenced angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker therapy during follow‐up and who had an annual assessment on either side of this therapeutic change. Results At baseline, the patients had a mean age of 63.8 years, a median diabetes duration of 4 years, a median HbA 1c of 7.6% (60 mmol/mol) and a geometric mean ( sd range) urinary albumin:creatinine ratio of 3.3 mg/mmol (0.8–13.1 mg/mmol). The percentages with normo‐, micro‐ and macroalbuminuria were 49.0, 38.4 and 12.6%, respectively. During 6.1 ± 1.7 years of follow‐up, initiation of renin–angiotensin–aldosterone system blockade was associated with a larger geometric mean ( sd range) absolute albumin:creatinine ratio reduction in the patients with macroalbuminuria compared with those who had either normo‐ or microalbuminuria [−40.9 (−825.7 to 159.9) mg/mmol) vs. 1.7 (−1.6 to 20.0) mg/mmol and −0.5 (−23.0 to 39.5) mg/mmol, respectively; P < 0.001]. These changes remained significant after adjustment for changes in blood pressure and other potentially confounding variables, including drug dose and angiotensin‐converting enzyme genotype. The post‐treatment median albumin:creatinine ratios were 35.4 and 27.4% lower than before treatment in those with micro‐ or macroalbuminuria, respectively. Conclusions Usual‐care initiation of renin–angiotensin–aldosterone system blockade confers a quantitatively similar renal benefit to that in intervention trials in Type 2 diabetes.