Document Detail


Continuously evolving management concepts for diabetic CKD and ESRD.
MedLine Citation:
PMID:  20210916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
During the past 50 years, a global pandemic of kidney failure attributed to diabetes mellitus provoked continuously changing treatment strategies based in the belief that micro- and macrovascular complications of diabetes may be preventable. Both patient and physician have revised, and sometimes reversed drug regimens based on inferences extracted from prospective, controlled, properly populated trials. Illustrating this dilemma is a newly relaxed target for glycosylated hemoglobin (HbA1c) of 7%, introduced because of the greater rate of cardiovascular complications noted when striving to reduce attained HbA1c to < or = 6.5%. Our concept of the natural history of kidney disease in diabetes has repeatedly been modified by a rising mean age of those developing uremia (now 64.5 years). Underscoring the reality that the majority of diabetic kidney failure patients fall within the geriatric age group. An encouraging finding first reported in 2005 and continuing through 2009 is a declining incidence rate of irreversible advanced kidney failure in individuals known to have diabetes. That this "good news" results from appropriate renoprotective treatment is as yet unsubstantiated wishful thinking.
Authors:
Eli A Friedman
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-02-22
Journal Detail:
Title:  Seminars in dialysis     Volume:  23     ISSN:  1525-139X     ISO Abbreviation:  Semin Dial     Publication Date:    2010 Mar-Apr
Date Detail:
Created Date:  2010-06-07     Completed Date:  2010-09-28     Revised Date:  2010-11-10    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-9     Citation Subset:  IM    
Affiliation:
Department of Medicine, Nephrology Division, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. eli.friedman@downstate.edu
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MeSH Terms
Descriptor/Qualifier:
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use
Antilipemic Agents / therapeutic use
Diabetic Nephropathies / epidemiology,  therapy*
Hemoglobin A, Glycosylated / analysis
Humans
Hypoglycemic Agents / therapeutic use
Kidney Failure, Chronic / epidemiology,  therapy*
Kidney Transplantation
Pancreas Transplantation
Peritoneal Dialysis
Proteomics
Uremia / etiology,  prevention & control
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Antilipemic Agents; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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