Key result
Achieving all three ABC (HbA1c, blood pressure, and LDL-C) treatment targets was associated with a lower percentage of deterioration in GFR stages compared to achieving no targets over 6 years.
Why the study?
The associations of ABC (HbA1c, blood pressure, LDL cholesterol) goal attainment with chronic kidney disease progression in type 2 diabetic patients with preserved kidney function were investigated.
Does achieving more ABC (HbA1c, BP, LDL-C) goals prevent deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function?
Cohort (n=168)
No
Does achieving more ABC (HbA1c, BP, LDL-C) goals prevent deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function?
Answers are grounded in this paper and cite their sources.
Achieving multiple ABC (HbA1c, BP, LDL-C) treatment targets in type 2 diabetes patients with preserved kidney function is associated with reduced progression of chronic kidney disease and lower carotid IMT.
Background: We investigated cross-sectional and prospective associations of ABC (hemoglobin A1c (HbA1c), blood pressure and low-density lipoprotein cholesterol) goal attainment with chronic kidney disease. Cross-sectional association with carotid intima-media thickness (IMT) was evaluated as well. Methods: Prevalence of low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m 2 ) and albuminuria (urinary albumin-to-creatinine ratio (ACR) ? 30 mg/g) were assessed at baseline and after a median follow-up of 6.0 years in 168 patients with type 2 diabetes with preserved kidney function (aged 62.3 years, 53.6% men). Carotid IMT was measured at baseline only. Results: At baseline, 47 (28.0%), 45 (26.8%), 63 (37.5%) and 13 (7.7%) patients achieved triple-goal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC targets was associated with lower log ACR (P < 0.01), lower percentage of albuminuria (P = 0.02), and lower carotid IMT (P < 0.01) at baseline. Over 6.0 years, eGFR decreased from 76 ± 16 to 67 ± 18 mL/min/1.73 m 2 (P < 0.01) whereas ACR levels did not change. There were 32 patients with incident reduced eGFR, eight with GFR stage progression, 15 with progression of albuminuric stages and five with doubling of ACR within the microalbuminuric range. Achieving more ABC targets decreased the percentage of deterioration of GFR stages (30.8%, 28.6%, 24.4% and 14.9%, respectively, P = 0.01). Achieving two or more (8.9% and 8.5%, respectively) compared with one or less ABC targets (15.4% and 15.9%, respectively) was associated with less deterioration of albuminuria (P < 0.001). Although achieving more ABC targets was associated with lower annual decline in eGFR, the difference was not significant. Conclusions: ABC goal achievement has shown cross-sectional and prospective associations with deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function. Cross-sectional association with carotid IMT has been demonstrated as well. Reaching more ABC treatment targets may be important for preventing adverse renal outcomes. J Clin Med Res. 2019;11(12):818-824 doi: https://doi.org/10.14740/jocmr4001
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Minato et al. (2019) conducted a cohort in Type 2 diabetes with preserved kidney function (n=168). ABC (HbA1c, blood pressure, and LDL-C) goal achievement vs. Achieving fewer or no ABC goals was evaluated on Deterioration of GFR stages (p=0.01). Achieving all three ABC (HbA1c, blood pressure, and LDL-C) treatment targets was associated with a lower percentage of deterioration in GFR stages compared to achieving no targets over 6 years.
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