Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits

Abstract

In the present post hoc analyses we studied the impact of intensified, multifactorial treatment on renal outcomes in patients with type 2 diabetes and microalbuminuria enrolled in the Steno-2 Study. Outcome measures were progression to macroalbuminuria, decline in the glomerular filtration rate (GFR), and development of end stage renal disease (ESRD). In total, 160 patients with type 2 diabetes and microalbuminuria were recruited and assigned to conventional or intensified therapy targeting multiple risk factors. The mean duration of the intervention was 7.8 years after which all patients were offered intensified therapy over a total follow-up up to 21 years on albuminuria, GFR, ESRD and mortality. Progression to macroalbuminuria was significantly reduced in the intensive-therapy group with a hazard ratio of 0.51 [95% confidence interval 0.32, 0.84]. The decline in GFR was significantly different with 3.1 ml/min/year in the intensive-therapy group compared to 4.0 in the conventional-therapy group. Progression to ESRD trended towards a decreased hazard with an adjusted ratio in the intensive group of 0.36 [0.12, 1.05]. ESRD combined with death had a significantly reduced hazard ratio of 0.53 [0.35, 0.8]. Thus, intensified, multifactorial treatment slowed progression in nephropathy and renal function loss reducing the risk of ESRD.

Keywords: chronic kidney disease; diabetic nephropathy; end-stage renal disease; microalbuminuria; type 2 diabetes.