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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

Authors: Fegan, P. G.; Davis, W. A.¹; Kamber, N.; Sivakumar, S.; Beilby, J.²; Davis, T. M. E.¹

Source: Diabetic Medicine, Volume 28, Number 7, July 2011 , pp. 849-855(7)

Publisher: Wiley-Blackwell

Abstract:

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 (sdrange) 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 (sdrange) 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.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1464-5491.2011.03230.x

Affiliations: University of Western Australia, School of Medicine and Pharmacology Biochemistry Department, PathWest, Nedlands, WA, Australia

Publication date: 2011-07-01

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