WITH 45% of dialysis patients presenting as a result of diabetic kidney disease or with comorbidity of diabetes, studies are examining blood sugar control as a means to improving outcomes for this large segment of the dialysis population.

END-STAGE renal disease (ESRD) is affecting a growing proportion of type 2 diabetics in Australia and New Zealand, a study found.

CHICAGO—Telmisartan (Micardis HCT), a novel angiotensin receptor blocker (ARB), and the older ARB losartan have similar BP-lowering efficacy in hypertensive patients with diabetic nephropathy, but treatment with the new agent is associated with larger reductions in proteinuria, new findings show.

The kidney consists of four basic tissue types: vessels, glomeruli, tubules, and interstitium. Each of these types may be influenced by different pathophysiologic mechanisms associated with diabetic nephropathy. Despite their variability, these mechanisms share common clinical outcomes including microalbuminuria, progesssion to end-stage renal disease, and increased risks of cardiovascular morbidity and mortality.

MEASURED BY glycosylated hemoglobin A1c (HbA1c), poor diabetic metabolic control correlates with the complications such as nephropathy, as demonstrated in two important studies, the Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study. Therefore, it should come as no surprise that inadequate glycemic control in diabetic patients not on dialysis is associated with greater macrovascular complications, including MI, stroke, and peripheral vascular disease.

Adding spironolactone to an ACE inhibitor or angiotensin II receptor blocker (ARB) is associated with a marked and sustained antiproteinuric effect in type 2 diabetics, researchers in the Netherlands found.

KIDNEY DISEASE linked to diabetes, hypertension, and obesity is increasing throughout the world. It is estimated that diabetes leading to end-stage renal disease (ESRD) accounts for 40% of the patients who require kidney transplants in the United States, Europe, Japan, Australia, and New Zealand.

RENAL HYPERTROPHY is a major factor in the development of diabetic nephropathy in patients with type 1 diabetes.

Patients with diabetic nephropathy who are candidates for kidney or kidney- pancreas transplantation should be screened routinely with coronary angiography, researchers in Norway conclude.

Eli Lilly and Company has received an approvable letter from the FDA requesting additional supporting data for its new drug application for ruboxistaurin mesylate (proposed trade name: Arxxant), Lilly's investigational oral therapy for diabetic retinopathy.