Fenofibrate reduces progression to microalbuminuria over 3 years in a placebo-controlled study in type 2 diabetes: Results from the Diabetes Atherosclerosis Intervention Study (DAIS)

被引:203
作者
Ansquer, JC
Foucher, C
Rattier, S
Taskinen, MR
Steiner, G
机构
[1] Fournier Pharma, Dept Clin Res & Med Affairs, Daix, France
[2] Fournier Pharma, Dept Biometr, Daix, France
[3] Univ Helsinki, Cent Hosp, Biomedicum Helsinki, Helsinki, Finland
[4] Toronto Gen Hosp, Toronto, ON, Canada
关键词
albumin excretion; type; 2; diabetes; fenofibrate;
D O I
10.1053/j.ajkd.2004.11.004
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. In the Diabetes Atherosclerosis Intervention Study (DAIS), treatment of people with type 2 diabetes with micronized fenofibrate for an average of 38 months reduced the progression of angiographically evaluated coronary artery disease and improved lipoprotein level abnormalities compared with placebo. The aim of this analysis is to study the influence of the treatment on changes in urinary albumin excretion. Methods: Microalbuminuria was measured on 2 to 3 occasions by using timed overnight samples at baseline and yearly thereafter in 314 DAIS participants (77 women, 237 men; average age, 56 years); all except 3 participants had either a normal albumin excretion rate (<20 mu g/min; n = 214) or microalbuminuria (albumin, 20 to 200 mu g/min; n = 97) before randomization. Tabulated shifts (between normal, microalbuminuria, and macroalbuminuria) from baseline to last observed values were compared between treatment groups by means of chi-square or Fisher's exact test. Results: Fenofibrate significantly reduced the worsening of albumin excretion (fenofibrate, 8% versus placebo, 18%; P < 0.05). This effect was caused mostly by reduced progression from normal albumin excretion to microalbuminuria: 3 of 101 participants in the fenofibrate group versus 20 of 113 participants in the placebo group (P < 0.001). Overall, changes in albumin excretion were independent of age or changes in lipid or creatinine levels, weight, or blood pressure. Conclusion: Improvement in lipid profiles with fenofibrate in patients with type 2 diabetes was associated with reduced progression from normal albumin excretion to microalbuminuria.
引用
收藏
页码:485 / 493
页数:9
相关论文
共 21 条
[1]   Effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria [J].
Asselbergs, FW ;
Diercks, GFH ;
Hillege, HL ;
van Boven, AJ ;
Janssen, WMT ;
Voors, AA ;
de Zeeuw, D ;
de Jong, PE ;
van Veldhuisen, DJ ;
van Gilst, WH .
CIRCULATION, 2004, 110 (18) :2809-2816
[2]   Microalbuminuria in type 2 diabetes: An independent predictor of cardiovascular mortality [J].
Beilin, J ;
Stanton, KG ;
McCann, VJ ;
Knuiman, MW ;
Divitini, ML .
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1996, 26 (04) :519-525
[3]   Safety and immunogenicity of three doses of an eleven-valent diphtheria toxoid and tetanus protein-conjugated pneumococcal vaccine in Filipino infants -: art. no. 17 [J].
Capeding, MZR ;
Puumalainen, T ;
Gepanayao, CP ;
Käyhty, H ;
Lucero, MG ;
Nohynek, H .
BMC INFECTIOUS DISEASES, 2003, 3 (1)
[4]  
Deighan CJ, 2001, J AM SOC NEPHROL, V12, P341, DOI 10.1681/ASN.V122341
[5]  
Diercks GFH, 2002, CAN J CARDIOL, V18, P525
[6]   Effect of lipid reduction on the progression of renal disease: A meta-analysis [J].
Fried, LF ;
Orchard, TJ ;
Kasiske, BL .
KIDNEY INTERNATIONAL, 2001, 59 (01) :260-269
[7]   Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes [J].
Gaede, P ;
Vedel, P ;
Larsen, N ;
Jensen, GVH ;
Parving, H ;
Pedersen, O .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (05) :383-393
[8]   Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: Prospective, observational study [J].
Gall, MA ;
Hougaard, P ;
BorchJohnsen, K ;
Parving, HH .
BMJ-BRITISH MEDICAL JOURNAL, 1997, 314 (7083) :783-788
[9]   Treatment of the patient with diabetes mellitus and risk of nephropathy - What do we know, and what do we need to learn? [J].
Hollenberg, NK .
ARCHIVES OF INTERNAL MEDICINE, 2004, 164 (02) :125-130
[10]   Effects of fenofibrate on albuminuria in patients with hypertriglyceridemia and/or hyperuricemia: A multicenter, randomized, double-blind, placebo-controlled, crossover study [J].
Kazumi, T ;
Hirano, T ;
Yoshino, G .
CURRENT THERAPEUTIC RESEARCH-CLINICAL AND EXPERIMENTAL, 2003, 64 (07) :434-446