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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the 2012 revisions to the National Kidney Foundation and Kidney Disease Outcomes Quality Initiative 2007 guidelines. Revisions were made in Guideline 2 (Management of Hyperglycemia and General Diabetes Care in Chronic Kidney Disease [CKD]), Guideline 4 (Management of Dyslipidemia in Diabetes and Chronic Kidney Disease), and Guideline 6 (Management of Albuminuria in Normotensive Patients With Diabetes).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EFeatured Meeting - Specialty page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERudy Bilous, MD, Newcastle University, Newcastle upon Tyne, United Kingdom, discussed the 2012 revisions to the National Kidney Foundation and Kidney Disease Outcomes Quality Initiative 2007 guidelines. Revisions were made in Guideline 2 (Management of Hyperglycemia and General Diabetes Care in Chronic Kidney Disease [CKD]), Guideline 4 (Management of Dyslipidemia in Diabetes and Chronic Kidney Disease), and Guideline 6 (Management of Albuminuria in Normotensive Patients With Diabetes). The guidance is expected to be published in the September\/October 2012 issue of the \u003Cem\u003EAmerican Journal of Kidney Diseases\u003C\/em\u003E and will also be available online at \u003Ca href=\u0022http:\/\/www.kidney.org\/professionals\/KDOQI\/index.cfm\u0022\u003Ehttp:\/\/www.kidney.org\/professionals\/KDOQI\/index.cfm\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERevisions to Guideline 2:\u003C\/h2\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-3\u0022\u003E2.1: A target HbA1C of \u223c7.0% is recommended to prevent or delay progression of the microvascular complications of diabetes, including diabetic kidney disease\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-4\u0022\u003E2.2: Treating patients at risk of hypoglycemia to an HbA1C target of \u0026lt;7.0% is not recommended\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-5\u0022\u003E2.3: Target HbA1C should be extended above 7.0% in individuals with comorbidities or limited life expectancy and risk of hypoglycemia\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThese revisions were based on the lack of data that suggested true efficacy for glycemic control in kidney disease in patients with type 2 diabetes. Although observational studies suggest that better glycemic control leads to less risk of death and vascular disease in patients with type 2 diabetes [Selvin E et al. \u003Cem\u003EDiabetes\u003C\/em\u003E 2011; DCCT\/EDIC Research Group \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011], randomized clinical trials in these patients did not detect clinically significant reductions in cardiovascular disease or mortality with very intensive glycemic control [Patel A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2008; Duckworth W et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009]. In a meta-analysis (n=27,769) that compared intensive (most with HbA1C \u0026lt;7%) with conventional glycemic control, investigators reported no statistically significant effect of intensive glycemic control on nephropathy [Hemmingsen B et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2011].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERevisions to Guideline 4:\u003C\/h2\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003E4.1: Low-density lipoprotein-cholesterol (LDL-C)-lowering medicines, such as statins or statin\/ezetimibe combinations, are recommended to reduce the risk of major atherosclerotic events in patients with diabetes and CKD, including those who have received a kidney transplant\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003E4.2: Initiation of statin therapy in patients with diabetes who are treated by dialysis is not recommended.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThese changes were based on a number of studies of diabetes and CKD that showed small to no effect of lipid lowering on glomerular filtration rate. In the Study of Heart and Renal Protection [SHARP; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00125593\u0026amp;atom=%2Fspmdc%2F12%2F10%2F27.atom\u0022\u003ENCT00125593\u003C\/a\u003E], reduction of LDL-C with statins reduced the incidence of major atherosclerotic events in patients with diabetes but had no effect on mortality [Baigent C et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. These findings were the basis for the changes regarding statin therapy in the predialysis population (4.2).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERevisions to Guideline 6:\u003C\/h2\u003E\n         \u003Cul class=\u0022list-unord \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003E6.1: Use of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) for the primary prevention of diabetic kidney disease in normotensive normoalbuminuric patients with diabetes is not recommended (1A)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-11\u0022\u003E6.2: Use of an ACE inhibitor or an ARB in normotensive patients with diabetes and albuminuria levels \u226530 mg\/g who are at high risk of diabetic kidney disease or its progression is not recommended (2C)\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EClinical evidence has failed to provide evidence that ACE inhibitors or ARBs can prevent the development of microalbuminuria in normotensive normoalbuminuric patients, but there are some signs that renin-angiotensin system (RAS) blockade may be effective in preventing the development of microalbuminuria in patients with type 2 diabetes. Prof. Bilous cautioned that the majority of the patients in all of the studies were hypertensive. In addition, there were varying levels of blood pressure control among the studies, with the studies achieving the best control being neutral in terms of any preventive effect. What the studies do tell us, Prof. Bilous said, is that \u201cwe need to manage blood pressure effectively in patients with type 2 diabetes, and while RAS blockade may be an important part of that blood pressure control, it may not be the RAS blockers \u003Cem\u003Eper se\u003C\/em\u003E that reduce albuminuria.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/10\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznf7d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}