DIABETIC NEPHROPATHY - AN OBSERVATIONAL STUDY ON PATIENTS ATTENDING AJOINT DIABETES RENAL CLINIC

Diabetic nephropathy is a major cause of renal failure, accounting for 20% of patients starting dialysis. in clinical trials, effective bloo d-pressure control, especially by angiotensin-converting-enzyme inhibi tors (ACEIs), retards the rate of progression of renal failure substan tially. We examined these effects in clinical practice by surveying pa tients at a joint diabetes renal clinic at Glasgow Royal Infirmary fro m 1989 to 1995. We examined the relationship between progression of di abetic nephropathy, mean arterial pressure (MAP), and the use of ACEIs . The average MAP of the whole group of patients fell by 7%, the urine albumin:creatinine ratio fell by 29%, and the rate of progression as measured by the slope of reciprocal of serum creatinine with time (I/m u mol/day) was slowed, from -4.59 to -2.76. This is equal to delaying the necessity for dialysis by about 2 years. The joint clinic met its aim and was cost-effective.