Nephropathy and blood pressure

Burrows et al. (abstract 266) analyzed the incidence of end-stage renal disease (ESRD) in individuals with diabetes, using data from the U.S. Renal Data System and estimates of the U.S. population with diabetes from the National Health Interview Survey, and found that although the number of diabetic individuals beginning treatment for ESRD increased from 17,728 in 1990 to 45,951 in 2005, the age-adjusted incidences were 299, 343, and 201 per 100,000 diabetic population in 1990, 1996, and 2005, respectively, with decreases in incidence consistently seen in 2005 among diabetic individuals aged <45, 45–64, 65–74, and >75 years—perhaps an indication that ESRD is being successfully prevented. There remain important areas for intervention. Kim et al. (abstract 748) studied 3,239 Pima Indians aged 5–19 years. Microalbuminuria and macroalbuminuria were found in 7 and 1% of nondiabetic and in 29 and 2% of diabetic children, respectively. Regression to normoalbuminuria was found in 76% of nondiabetic but only 20% of diabetic youth, whereas progression to macroalbuminuria was seen at annual rates <1% in nondiabetic youth with microalbuminuria but 4 and 12% in diabetic patients with albumin-to-creatinine ratios 30–100 and 100–300 mg/g, respectively. Orchard and Costacou (abstract 973) compared 208 type 1 diabetic patients with intermittent versus persistent microalbuminuria and found the latter group to be 14 times more likely to progress to macroalbuminuria. Persistent microalbuminuria was associated with higher A1C, systolic blood pressure, and pulse. Cignarelli et al. (abstract 734) reported that among 407 type 2 diabetic patients, there were 55 subjects with glomerular filtration rate (GFR) <60 ml/min of whom 76% were normoalbuminuric. Although A1C, lipids, statin use, and glycemic treatment were similar in those …