Featured Research

from universities, journals, and other organizations

Diabetics are not benefiting from advances in kidney care

Date:
February 24, 2011
Source:
American Society of Nephrology
Summary:
Despite significant advances in kidney care over the past 20 years, efforts to improve therapy for Type 1 diabetes patients with kidney dysfunction remain unsuccessful, according to a new study. The results suggest that more effective therapies are needed for these patients.

Despite significant advances in kidney care over the past 20 years, efforts to improve therapy for type 1 diabetes patients with kidney dysfunction remain unsuccessful, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results suggest that more effective therapies are needed for these patients.

One in three patients with type 1 diabetes develops a condition called macroalbuminuria, where especially high amounts of protein are lost through the urine. Patients with type 1 diabetes and macroalbuminuria face increased risks of developing kidney failure, or end stage renal disease (ESRD), and of dying from heart-related causes. Andrzej Krolewski, MD, PhD (Joslin Diabetes Center and Brigham and Women's Hospital) and his colleagues studied these risks in patients at the Joslin Clinic, a large institution that specializes in the care of patients with diabetes and where new clinical protocols are promptly adopted and implemented.

Between 1991 and 2004, the investigators enrolled 423 white patients with type 1 diabetes who developed macroalbuminuria. Ninety-eight percent of patients were followed through 2008; ESRD developed in 172 patients, and 29 died without ESRD. The majority of these outcomes occurred between ages 36 and 52 years with durations of diabetes of 21 to 37 years.

During the more than 15 years of follow-up, the use of treatments to protect the kidneys increased from 56% to 82%, and blood pressure and cholesterol levels improved significantly. However, the risks for both ESRD and pre-ESRD death did not change over that time. There were 70 post-ESRD deaths, and the mortality rate was very similar during the 1990s and the 2000s. Throughout the study, patients who received pre-emptive kidney transplants (before dialysis) were less likely to die.

"Our findings clearly indicate that the accomplishments in treatment of patients with type 1 diabetes and macroalbuminuria over the last 20 years are not effective enough, and more effective therapies to retard progression to ESRD are desperately needed," said Dr. Krolewski. "New therapies need to be developed including more aggressive or experimental protocols to stop or retard declining renal function, which leads to ESRD," he added.

Study co-authors include Elizabeth Rosolowsky, MD (Joslin Diabetes Center and Children's Hospital, Boston); Jan Skupien, MD, Monika Niewczas, MD, PhD (Joslin Diabetes Center and Brigham and Women's Hospital); Adam Smiles, James Warram, MD, ScD (Joslin Diabetes Center); Bijan Roshan, MD, Robert Stanton, MD (Joslin Diabetes Center and Beth Israel Deaconess Medical Center); and John Eckfeldt, MD, PhD (University of Minnesota). The study was inspired by Diego Cantarovich, MD, PhD (Nantes University Hospital, in Nantes, France), who asked the investigators for data to design the Pancreas Allotransplantation for Diabetic Nephropathy and Mild Chronic Renal Failure Stage Study.

In reviewing the results of this study in an accompanying editorial, Robert Nelson, MD, PhD (National Institute of Diabetes and Digestive and Kidney Diseases) noted that it raises important questions about the effectiveness of efficacious treatments in patients with type 1 diabetes and macroalbuminuria, where efficacy refers to the effect of a treatment in a controlled environment where the extraneous effects of other factors are eliminated, and effectiveness refers to the effect of the same treatment in a real-world population. For example, "what factors determine whether efficacious treatments will be clinically effective? And what roles do age, ethnicity, type of diabetes, and stage of disease play in determining effectiveness of an intervention?" he asked. He added that while the study authors argue that new therapies are needed, "a careful examination of the process of healthcare delivery may also identify points in translation where corrective steps can be taken to enhance therapeutic effectiveness."


Story Source:

The above story is based on materials provided by American Society of Nephrology. Note: Materials may be edited for content and length.


Journal References:

  1. Robert Nelson. Is Treatment of Nephropathy in Type 1 Diabetes Efficacious but Ineffective? Journal of the American Society Nephrology, February 24, 2011 DOI: 10.1681/ASN.2011010076
  2. Andrzej Krolewski et al. Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection. Journal of the American Society Nephrology, February 24, 2011 DOI: 10.1681/ASN.2010040354

Cite This Page:

American Society of Nephrology. "Diabetics are not benefiting from advances in kidney care." ScienceDaily. ScienceDaily, 24 February 2011. <www.sciencedaily.com/releases/2011/02/110224201855.htm>.
American Society of Nephrology. (2011, February 24). Diabetics are not benefiting from advances in kidney care. ScienceDaily. Retrieved April 17, 2014 from www.sciencedaily.com/releases/2011/02/110224201855.htm
American Society of Nephrology. "Diabetics are not benefiting from advances in kidney care." ScienceDaily. www.sciencedaily.com/releases/2011/02/110224201855.htm (accessed April 17, 2014).

Share This



More Health & Medicine News

Thursday, April 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Could Even Casual Marijuana Use Alter Your Brain?

Could Even Casual Marijuana Use Alter Your Brain?

Newsy (Apr. 16, 2014) A new study conducted by researchers at Northwestern and Harvard suggests even casual marijuana use can alter your brain. Video provided by Newsy
Powered by NewsLook.com
Thousands Of Vials Of SARS Virus Go Missing

Thousands Of Vials Of SARS Virus Go Missing

Newsy (Apr. 16, 2014) A research institute in Paris somehow misplaced more than 2,000 vials of the deadly SARS virus. Video provided by Newsy
Powered by NewsLook.com
Formerly Conjoined Twins Released From Dallas Hospital

Formerly Conjoined Twins Released From Dallas Hospital

Newsy (Apr. 16, 2014) Conjoined twins Emmett and Owen Ezell were separated by doctors in August. Now, nearly nine months later, they're being released from the hospital. Video provided by Newsy
Powered by NewsLook.com
Ebola Outbreak Now Linked To 121 Deaths

Ebola Outbreak Now Linked To 121 Deaths

Newsy (Apr. 15, 2014) The ebola virus outbreak in West Africa is now linked to 121 deaths. Health officials fear the virus will continue to spread in urban areas. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins