Aggressive Antihypertensive Treatment and Serum Lipid Lowering Therapy Are Necessary to Prevent Deterioration of the Renal Function Even in Elderly Type 2 Diabetic Patients with Persistent Albuminuria

Abstract

Background: In elderly patients with diabetic nephropathy, clinical information aiming at preventing a decline of the renal function is limited. Objective: To clarify factors that could be related to changes in renal function in elderly diabetic patients with persistent albuminuria. Methods: We studied the relationships between the declining rate of creatinine clearance (Ccr) and other clinical features – glycemic control, blood pressure (BP), the degree of albuminuria, and other confounding factors – retrospectively in elderly diabetic patients with persistent albuminuria. Results: We analyzed 17 elderly diabetic patients with persistent albuminuria (4 men and 13 women, mean age 68.0 ± 5.7 years at the beginning of the observation period) for 3.7 ± 1.5 (SD) years. We found that the last value of the urinary albumin excretion (UAE) of the observation period and the individual mean values of systolic BP, mean BP, and serum cholesterol closely correlated with the rate of decline in Ccr estimated by Cockcroft’s formula. The last UAE closely correlated with the individual mean values of systolic BP and mean BP. For patients such as the present subjects, adequate retardation of decline in renal function requires that the estimated goal of antihypertensive treatment should be a BP below 130/70 mm Hg. The level of glycemic control and the use of angiotensin-converting enzyme inhibitors did not correlate with the rate of decline in Ccr. Conclusion: Aggressive antihypertensive treatment and serum lipid lowering therapy may be necessary to prevent deterioration of the renal function in elderly type 2 diabetic patients with persistent albuminuria.