title: Ongoing treatment with renin-angiotensin-aldosterone-blocking agents does not predict normoalbuminuric renal impairment in a general type 2 diabetes population.
abstract: OBJECTIVE
  To examine the prevalence and the clinical characteristics associated with normoalbuminuric renal impairment (RI) in a general type 2 diabetes (T2D) population.
  
  
  METHODS
  We included 94 446 patients with T2D (56% men, age 68.3±11.6 years, BMI 29.6±5.3 kg/m², diabetes duration 8.5±7.1 years; means±SD) with renal function (serum creatinine) reported to the Swedish National Diabetes Register (NDR) in 2009. RI was defined as estimated glomerular filtration (eGFR)<60 ml/min/1.73 m² and albuminuria as a urinary albumin excretion rate (AER) >20 μg/min. We linked the NDR to the Swedish Prescribed Drug Register, and the Swedish Cause of Death and the Hospital Discharge Register to evaluate ongoing medication and clinical outcomes.
  
  
  RESULTS
  17% of the patients had RI, and 62% of these patients were normoalbuminuric. This group of patients had better metabolic control, lower BMI, lower systolic blood pressure and were more often women, non-smokers and more seldom had a history of cardiovascular disease as compared with patients with albuminuric RI. 28% of the patients with normoalbuminuric RI had no ongoing treatment with any RAAS-blocking agent. Retinopathy was most common in patients with RI and albuminuria (31%).
  
  
  CONCLUSIONS
  The majority of patients with type 2 diabetes and RI were normoalbuminuric despite the fact that 25% of these patients had no ongoing treatment with RAAS-blocking agents. Thus, RI in many patients with type 2 diabetes is likely to be caused by other factors than diabetic microvascular disease and ongoing RAAS-blockade.
authors.affiliation: Department of Nephrology, Kärnsjukhuset, Skövde, Sweden.
authors.forename: Hanri
authors.initials: H
authors.lastname: Afghahi
authors.forename: Mervete
authors.initials: M
authors.lastname: Miftaraj
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.forename: Henrik
authors.initials: H
authors.lastname: Hadimeri
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
authors.forename: Björn
authors.initials: B
authors.lastname: Eliasson
authors.forename: Maria K
authors.initials: MK
authors.lastname: Svensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012084:Renin-Angiotensin System / Q000187:drug effects; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents