Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group.


:The Diabetes Control and Complications Trial (DCCT) has demonstrated that intensive diabetes treatment delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy in patients with IDDM. A detailed description of the effects of this treatment on diabetic nephropathy is presented here. In the primary prevention cohort, intensive treatment reduced the mean adjusted risk of the cumulative incidence of microalbuminuria (> or = 28 micrograms/min) by 34% (95% CI 2, 56%; P = 0.04). Furthermore, intensive treatment decreased the albumin excretion rate (AER) by 15% after the first year of therapy (6.5 vs. 7.7 micrograms/min, P < 0.001). Thereafter the rates of change for AER within each treatment group were no different from zero, retaining a constant difference in AER between groups in the trial. In the secondary intervention cohort with baseline AER < 28 micrograms/min, intensive therapy reduced the mean adjusted risk of microalbuminuria (> or = 28 micrograms/min) by 43% (95% CI 21, 58%; P < 0.0001); the risk of a more advanced level of microalbuminuria (> or = 70 micrograms/min) by 56% (95% CI 26, 74%; P = 0.002); and the risk of clinical albuminuria (> or = 208 micrograms/min) by 56% (95% CI 18, 76%; P < 0.01). In the secondary intervention cohort, values for AER at year 1 were identical at 9 micrograms/min, but the 6.5% change per year in the conventional group greatly exceeded the rate of change of -0.3% in the intensive group (P < 0.001). Among the 73 secondary cohort subjects with AER levels > or = 28 micrograms/min but < or = 139 micrograms/min at baseline, the reduction of progression to clinical albuminuria with intensive therapy was not statistically significant. The longitudinal treatment effect of conventional versus intensive therapy (11.0% vs. 2.5% per year, respectively, P = 0.087) was similar in magnitude to that among patients with AER < 28 micrograms/min at baseline. For the primary, secondary and combined cohorts, there were no significant differences in the rates of change in creatinine clearance (CCr) between treatment groups during the study. Only seven subjects in the entire study (2 intensive, 5 conventional) developed urinary AER > or = 208 micrograms/min coupled with a CCr < 70 ml/min/1.73 m2. Neither the rate of change of blood pressure nor the appearance of hypertension (BP > 140/90 mm Hg) differed significantly between treatment groups in the primary, secondary or combined cohorts.(ABSTRACT TRUNCATED AT 400 WORDS)


Kidney Int


Kidney international





Has Abstract


1995-06-01 00:00:00














  • Mechanism of attenuated hydrochlorothiazide response during indomethacin administration.

    abstract::Indomethacin antagonizes the natriuretic and chloruretic response to hydrochlorothiazide in most studies. Neither the mechanism nor nephron site of this antagonism has been determined. To identify sites and potential mechanisms, cortical micropuncture was performed during hydrochlorothiazide treatment in control and i...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Kirchner KA,Brandon S,Mueller RA,Smith MJ,Bower JD

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  • T-cell exhaustion correlates with improved outcomes in kidney transplant recipients.

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    authors: Fribourg M,Anderson L,Fischman C,Cantarelli C,Perin L,La Manna G,Rahman A,Burrell BE,Heeger PS,Cravedi P

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  • Abnormal hemodynamics and elevated angiotensin II plasma levels in polydipsic patients on regular hemodialysis treatment.

    abstract::To investigate the cause and the mechanisms responsible of the compulsive thirst and excessive fluid intake observed in many patients on chronic dialysis treatment, we measured plasma antidiuretic hormone (ADH), angiotensin II (Ang II) and some hemodynamic parameters in seven polydipsic and in six normodipsic patients...

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    更新日期:1993-07-01 00:00:00

  • Multicenter trial of one HLA-DR-matched or mismatched blood transfusion prior to cadaveric renal transplantation.

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Mitnick P,Greenberg A,Coffman T,Kelepouris E,Wolf CJ,Goldfarb S

    更新日期:1982-04-01 00:00:00

  • Pre-existing renal disease promotes sepsis-induced acute kidney injury and worsens outcome.

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    journal_title:Kidney international

    pub_type: 杂志文章


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    更新日期:2008-10-01 00:00:00

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    abstract::Identifying subjects with progressive chronic kidney disease will be important both in clinical practice and in conducting clinical trials. Pruijm et al. (in this issue) demonstrate for the first time that cortical oxygenation as evaluated by blood oxygenation level-dependent magnetic resonance imaging can predict fut...

    journal_title:Kidney international

    pub_type: 评论,杂志文章


    authors: Prasad PV

    更新日期:2018-04-01 00:00:00

  • Prognostic value of inducible myocardial ischemia in predicting cardiovascular events after renal transplantation.

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    pub_type: 杂志文章


    authors: Dussol B,Bonnet JL,Sampol J,Savin B,De La Forte C,Mundler O,Habib G,Morange S,Barrau K,Loundoun A,Vacher-Coponat H,Berland Y

    更新日期:2004-10-01 00:00:00

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    pub_type: 杂志文章


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    journal_title:Kidney international

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    authors: Cerini C,Geider S,Dussol B,Hennequin C,Daudon M,Veesler S,Nitsche S,Boistelle R,Berthézène P,Dupuy P,Vazi A,Berland Y,Dagorn JC,Verdier JM

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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Ries M,Bettis KE,Choyke P,Kopp JB,Austin HA 3rd,Brady RO,Schiffmann R

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    更新日期:2016-02-01 00:00:00

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    authors: Rui-Mei L,Kara AU,Sinniah R

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    authors: Fernández-Juárez G,Rojas-Rivera J,Logt AV,Justino J,Sevillano A,Caravaca-Fontán F,Ávila A,Rabasco C,Cabello V,Varela A,Díez M,Martín-Reyes G,Diezhandino MG,Quintana LF,Agraz I,Gómez-Martino JR,Cao M,Rodríguez-Moreno A,

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  • Renal growth hormone--insulin-like growth factor-I system in acute renal failure.

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    journal_title:Kidney international

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    journal_title:Kidney international

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    authors: Krumme B,Blum U,Schwertfeger E,Flügel P,Höllstin F,Schollmeyer P,Rump LC

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  • Expansion of cytolytic CD4+CD28- T cells in end-stage renal disease.

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    authors: Betjes MG,Huisman M,Weimar W,Litjens NH

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  • Effect of nitric oxide modulation on TGF-beta1 and matrix proteins in chronic cyclosporine nephrotoxicity.

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    journal_title:Kidney international

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    authors: Shihab FS,Yi H,Bennett WM,Andoh TF

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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Hering-Smith KS,Hamm LL

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    pub_type: 杂志文章


    authors: Alcorta DA,Barnes DA,Dooley MA,Sullivan P,Jonas B,Liu Y,Lionaki S,Reddy CB,Chin H,Dempsey AA,Jennette JC,Falk RJ

    更新日期:2007-10-01 00:00:00

  • Bone resorption and mRNA expression of IL-6 and IL-6 receptor in patients with renal osteodystrophy.

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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Langub MC Jr,Koszewski NJ,Turner HV,Monier-Faugere MC,Geng Z,Malluche HH

    更新日期:1996-08-01 00:00:00

  • Recurrence of ANCA-associated vasculitis following renal transplantation in the modern era of immunosupression.

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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Gera M,Griffin MD,Specks U,Leung N,Stegall MD,Fervenza FC

    更新日期:2007-06-01 00:00:00

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    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Steffes MW,Buchwald H,Wigness BD,Groppoli TJ,Rupp WM,Rohde TD,Blackshear PJ,Mauer SM

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    journal_title:Kidney international

    pub_type: 评论,杂志文章


    authors: Zareba W

    更新日期:2015-11-01 00:00:00