Preventing diabetic nephropathy: an audit

In type 1 diabetic patients with microalbuminuria not receiving antihyperte nsive treatment. an increase in urinary albumin excretion rate (AER) of 6% to 14%/year and a risk for the development of diabetic nephropathy of 3% to 30%/year have previously been reported. The aim of the present study was t o audit the effect of angiotensin converting enzyme (ACE) inhibition on the progression of microalbuminuria and development of diabetic nephropathy. W e consecutively identified 227 type 1 diabetic patients with persistent mic roalbuminuria (urinary AER between 30 and 300 mg/24h, ELISA). According to the level (greater than or equal to 100 or < 100 mg/24 h) and/or rate of pr ogression in urinary AER (>6% or less than or equal to6%/year), patients we re divided into a high-risk group (n = 177) and a low-risk group (n = 50) f or development of diabetic nephropathy. According to international guidelin es, all patients at high-risk were recommended ACE-inhibitor treatment. Thr oughout the study, 67% of the patients were treated with an ACE inhibitor. Urinary AER significantly declined by 8.3%/year (95% CI: 2.8 to 13.9) in th e whole group of patients, and the risk for the development of diabetic nep hropathy during follow-up was 3.5%/year. Glycaemic control and blood pressu re remained unchanged during the study. The implementation of modified inte rnational guidelines regarding the use of ACE inhibition in the treatment o f microalbuminuric type 1 diabetic patients reduced progression to diabetic nephropathy comparable to what has previously been reported in interventio n trials.