title: Improved survival and renal prognosis of patients with type 2 diabetes and nephropathy with improved control of risk factors.
abstract: OBJECTIVE
  To evaluate long-term survival, development of renal end points, and decline in glomerular filtration rate (GFR) in patients with type 2 diabetes and diabetic nephropathy (DN) after renin-angiotensin system (RAS) inhibition and multifactorial treatment of cardiovascular risk factors have become standard of care.
  
  
  METHODS
  All patients with type 2 diabetes and DN (n = 543) at the Steno Diabetes Center were followed during 2000-2010. GFR was measured yearly with 51Cr-EDTA plasma clearance. Annual decline in GFR was determined in patients with at least three measurements over a minimum of 3 years (∆GFR cohort, n = 286). Results were compared with historical data, obtained using identical criteria at our hospital, before implementation of current treatment guidelines.
  
  
  RESULTS
  Baseline mean (SD) GFR was 74 (32) mL/min/1.73 m2. More than 93% received RAS inhibition. During median 7.8 (interquartile range 5.7-9.8) years, mean (SE) annual GFR decline was 4.4 (0.24) compared with previously 5.2 (0.27) mL/min/1.73 m2/year (P = 0.04). Doubling of plasma creatinine or end-stage renal disease (ESRD) developed in 19%, and 37% died during 5.7 (3.3-8.8) years. Mortality from onset of DN in the ∆GFR cohort was compared with that of our prior ∆GFR cohort from 1983 to 2003 (n = 227). Crude mortality risk was reduced by 42% and after age adjustment by 50% (P < 0.001 for both). In a multistate model accounting for competing risks of ESRD and death, prior cardiovascular disease and lower GFR were predictors of mortality, whereas albuminuria, HbA1c, and low GFR predicted ESRD.
  
  
  CONCLUSIONS
  Overall prognosis has improved considerably with current multifactorial treatment of DN in type 2 diabetes, including long-term RAS inhibition.
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark gbad@steno.dk gugga77@gmail.com.
authors.forename: Gudbjörg
authors.initials: G
authors.lastname: Andrésdóttir
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Majken L
authors.initials: ML
authors.lastname: Jensen
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.affiliation: Department of Medical Endocrinology, Rigshospitalet, Copenhagen, DenmarkFaculty of Health Science, University of Copenhagen, Copenhagen, DenmarkHEALTH, University of Aarhus, Aarhus, Denmark.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Rossing
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.affiliation: Steno Diabetes Center, Gentofte, DenmarkFaculty of Health Science, University of Copenhagen, Copenhagen, DenmarkHEALTH, University of Aarhus, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
mesh_terms: D000328:Adult; D000419:Albuminuria; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors