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Q J Med 1999; 92: 275-282
© 1999 Association of Physicians

Can intensive treatment alter the progress of established diabetic nephropathy to end-stage renal failure?

T.G. Feest, E.J. Dunn and C.J. Burton

From The Richard Bright Renal Unit, Southmead Hospital, Bristol, UK

Received 18 December 1998 and in revised form 8 March 1999

Professor T.G. Feest, Richard Bright Renal Unit, Southmead Hospital, Southmead Road, Bristol BS10 5NB

Diabetic nephropathy is now the leading cause of end-stage renal disease in the Western world, and is associated with a higher patient morbidity and mortality than other causes of renal failure, largely because of associated cardiovascular disease. Numerous studies have elucidated the factors which influence its onset and progression. The St Vincent Declaration in 1994 proposed standards for the appropriate management of patients with diabetic nephropathy. We assessed whether referral to a nephrology clinic attempting to apply these standards influenced the progression of diabetic nephropathy. The results show a significant improvement in blood pressure, glycosylated haemoglobin and serum cholesterol following referral. There was a significant reduction in the rate of decline of renal function following referral in 39% of patients. With the possible exception of diabetic control there were no significant differences in the management of those that did and did not show improvement. The results show that with intensive out-patient clinic monitoring it is possible to improve the quality of patient care, and that even in established diabetic nephropathy it is possible to slow the rate of progression to end-stage renal failure.


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