PREDICTORS OF THE PROGRESSION OF DIABETIC NEPHROPATHY AND THE BENEFICIAL EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN NIDDM PATIENTS

A progressive decline in glomerular function occurs in diabetic nephro pathy. The predictive effects of progression promoters were examined i n 182 non-insulin-dependent diabetic patients from a baseline serum cr eatinine concentration of 133 mu ml/l. During a total of 605 person-ye ars follow-up, 107 patients developed end-stage renal failure requirin g dialysis. The rate of decline of renal function was highly variable. Urinary protein excretion was the strongest predictor correlated to t he rate of decline, followed by diastolic and systolic blood pressure, total cholesterol and platelet count, while the protective effects we re seen in serum albumin and haematocrit. Ajustment for urinary protei n excretion revealed that diastolic blood pressure, familial predispos ition to hypertension, serum albumin, and smoking were independent sig nificant predictors. Angiotensin converting enzyme inhibitors (ACE-I) significantly retarded the development of end-stage renal failure comp ared to antihypertensives other than ACE-I (mostly nifedipine), and th e effect was evident particularly in patients with proteinuria below t he median (2.5 g/24 h) (presumably those who responded to ACE-I). A co mplex effect of proteinuria in association with blood pressure elevati on, familial predisposition to hypertension, hypoalbuminaemia, and smo king may play an important role in the progression of nephropathy.