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K.Ounaissa, H.Jammoussi, A.Kacem, Ch.Amrouche, I.Ben Ahmed, O.Berriche, S.Blouza.

Effects of Angiotensin-Converting- Enzyme inhibitors on nephropathy outcomes in patients with type 1 diabetes. K.Ounaissa, H.Jammoussi, A.Kacem, Ch.Amrouche, I.Ben Ahmed, O.Berriche, S.Blouza. NATIONAL INSTITUTE OF NUTRITION, TUNIS –TUNISIA 10 th meeting of MGSD, Turkey, 26 – 29 April 2007.

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K.Ounaissa, H.Jammoussi, A.Kacem, Ch.Amrouche, I.Ben Ahmed, O.Berriche, S.Blouza.

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  1. Effects of Angiotensin-Converting- Enzyme inhibitors on nephropathy outcomes in patients with type 1 diabetes K.Ounaissa, H.Jammoussi, A.Kacem, Ch.Amrouche, I.Ben Ahmed, O.Berriche, S.Blouza. NATIONAL INSTITUTE OF NUTRITION, TUNIS –TUNISIA 10th meeting of MGSD, Turkey, 26 – 29 April 2007

  2. Introduction • Diabetic nephropathy is the most common cause for end-stage renal disease (ESRD). • It occurs in ~ 30 % of people with type 1 diabetes 25 – 40 % type 2 diabetes • Risk factors include hyperglycemia, hypertension, genetic predisposition, albuminuria,… • Early identification of patients who are at high risk is mandatory in order to prevent the development or progression of diabetic kidney injury.

  3. Microalbuminuriais the earliest marker, predicts progressive diabetic nephropathy(80 % of type 1 diabetics progress to overt nephropathy over a period of 10 – 15 years, GFR gradually falls, ESDR develops in 50 % within 10 years and > 75 % by 20 years) and cardiovascular diseases (endothelium dysfunction. • Necessity of specific interventions : - optimization of glucose control (DCCT, UKPDS) - optimization of blood pressure control - Screening and treatment of microalbuminuria (ACE inhibitors , ARBs) To reduce the risk and/or slow the progression of nephropathy

  4. Objective • Evaluate the effect of ACE inhibitors on the progression of nephropthy in type 1 diabetic patients.

  5. UAER (Urinary albumin excretion rate) was determined on a sample of 24 hours collected urines using immunoturbidimetric method. Cytobacteriological exam of urines Diagnosis of : Persistent microalbuminuria : if at least 2 of 3 analyses in a 6- month period were in the 30 – 299 mg range. Macroalbuminuria ≥ 300 mg /24h • Arterial blood pressure was measured at every visit Hypertension : BP ≥ 140 / 90 mmHg or antihypertensive treatment • Yearly screening and diagnosis of other degenerative complications (Ocular fundus …). • Renal function was evaluated after a follow up period of 2 years.

  6. Results

  7. Baseline characteristics of patients

  8. Degenerative complications of diabetes : 81%

  9. Evolution of nephropathy in patients treated by ACE-Inihibitors * P = 0.05

  10. Evolution of nephropathy in patients untreated by ACE-Inihibitors * p < 0.05 ** P < 0.01

  11. Evolution of nephropathy Diabetics treated by ACE Diabetics untreated by ACE

  12. Evolution of nephropathy P = 0.05 p < 0.05

  13. Discussion (1) • Several studies have shown that ACE inhibition is effective in reducing renal progression in both type 1 and type 2 diabetic patients with microalbuminuria. • Effect of ACE inhibition did not differ by sex, age, disease duration, glycemic control and baseline blood pressure, indicating benefit for all patients regardless of these variables.

  14. Discussion (2) A meta-analysis (ATLANTIS, ESPRIT, PRIMA, EUCLID…) showed that in normotensive patients with type 1 diabetes and microalbuminuria, ACE inhibitors : - reduced siginificantly progression from microalbuminuria to macroalbuminuria by 79%. - at 2 years, albumin excretion rate (AER) was 50.5 % lower in treated patients than in placebo group. - Adjustment for change in blood pressure attenuated the treatment difference to 45.1 %. Ann Int Med 2001, 134:370-379

  15. Conclusion • Annual screening for microalbuminuria to start specific treatment as soon as possible. - Optimal blood glucose and blood pressure controls - Blockage of the renin-angiotensin system with ACE (type 1 diabetes) and ARBs (type 2 diabetes) major therapeutic strategies to improve renal prognosis, reduce cardiovascular events and preserve life quality of diabetics.

  16. Thank you for your attention

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