March 24, 2016
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Intensive glucose control linked with ESRD reduction

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Long-term reduction in end-stage renal disease is linked with intensive glucose control without evidence of increased the risk for cardiovascular events or death.

Preserved kidney function and well-controlled blood pressure further elevated the benefits, according to researchers.

Vlado Perkovic , MBBS, PhD, FASN, FRACP, executive director of the George Institute in Australia, and colleagues evaluated data from the ADVANCE trial on 8,494 adults aged 55 years or older with type 2 diabetes to determine the long-term effects of intensive glucose control on the risk for ESRD and other outcomes. In-trial follow-up was conducted for a median 5 years, post-trial follow-up for a median 5.4 years and total follow-up for a median 9.9 years.

With intensive glucose control there was a significant reduction in the risk for ESRD during the in-trial period (P = .02) and after a total 9.9 years of follow-up (P < .01).

As chronic kidney disease stage increased there was a graded reduction in the strength of the effect of intensive glucose control on ESRD (P = .04 for heterogeneity). Compared with participants with baseline systolic BP levels greater than 140 mm Hg, a greater risk reduction in ESRD was found for those with systolic BP levels lower than 140 mm Hg (P = .01 for heterogeneity).

There was a nonsignificant effect on the risk for death due to renal disease during the in-trial period (HR = 0.85; 95% CI, 0.45-1.62) that remained after 9.9 years of follow-up (HR = 0.89; 95% CI, 0.6-1.31).

“Our data build on a growing body of evidence indicating an important role for intensive glucose control in limiting the progression of kidney disease and in curbing the growing number of patients around the world with type 2 diabetes requiring dialysis or transplantation as a result of diabetic kidney disease,” the researchers wrote. – by Amber Cox

Disclosure: Perkovic reports various financial ties with AbbVie, Astellas, AstraZeneca, Baxter, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Janssen, Merck, Pfizer, Roche and Servier. Please see the full study for a list of all other authors’ relevant financial disclosures.