Intensive glucose control improves kidney outcomes in patients with type 2 diabetes

Vlado Perkovic, Hiddo Lambers Heerspink, John Chalmers, Mark Woodward, Min Jun, Qiang Li, Stephen Macmahon, Mark E. Cooper, Pavel Hamet, Michel Marre, Carl Erik Mogensen, Neil Poulter, Alan Cass, Giuseppe Mancia, Anushka Patel, Sophia Zoungas, ADVANCE Collaborative Group

Research output: Contribution to journalArticlepeer-review

201 Citations (Scopus)

Abstract

The effect of intensive glucose control on major kidney outcomes in type 2 diabetes remains unclear. To study this, the ADVANCE trial randomly assigned 11,140 participants to an intensive glucose-lowering strategy (hemoglobin A1c target 6.5% or less) or standard glucose control. Treatment effects on end-stage renal disease ((ESRD), requirement for dialysis or renal transplantation), total kidney events, renal death, doubling of creatinine to above 200 μmol/l, new-onset macroalbuminuria or microalbuminuria, and progression or regression of albuminuria, were then assessed. After a median of 5 years, the mean hemoglobin A1c level was 6.5% in the intensive group, and 7.3% in the standard group. Intensive glucose control significantly reduced the risk of ESRD by 65% (20 compared to 7 events), microalbuminuria by 9% (1298 compared to 1410 patients), and macroalbuminuria by 30% (162 compared to 231 patients). The progression of albuminuria was significantly reduced by 10% and its regression significantly increased by 15%. The results were almost identical in analyses taking account of potential competing risks. The number of participants needed to treat over 5 years to prevent one ESRD event ranged from 410 in the overall study to 41 participants with macroalbuminuria at baseline. Thus, improved glucose control will improve major kidney outcomes in patients with type 2 diabetes.

Original languageEnglish
Pages (from-to)517-523
Number of pages7
JournalKidney International
Volume83
Issue number3
DOIs
Publication statusPublished - Mar 2013
Externally publishedYes

Keywords

  • blood pressure
  • cardiovascular events
  • chronic kidney disease
  • clinical trial
  • epidemiology and outcomes

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