73 m2 or kidney disease
at hospitalization) did not have albuminuria (ACR ≥ 30 mg/g).8 Cross-sectional studies in people with type 2 diabetes and microalbuminuria have generally shown GFR to be normal, however, increased GFR (hyperfiltration) have been observed. For example in a Danish study 158 microalbuminuric patients had an increased GFR of 139 ± 29 mL/min compared with 39 normoalbuminuric patients (115 ± 19 mL/min) and 20 control subjects without diabetes (111 ± 23 mL/min).9 However, the cross-sectional study by Premaratne et al.10 of 662 Australian people with type 2 diabetes showed no significant difference in AER and prevalence of microalbuminuria between hyperfilters and normofilters. Although not recognized PD0325901 cost as a stage of CKD, hyperfiltration (GFR > 130 mL/min
per 1.73 m2) represents an early phase of kidney dysfunction in diabetes. However, its clinical significance remains controversial. By definition, this phase can only be detected by measurement of GFR. In people who do not have diabetes, the expected rate of decline in GFR with ageing is approximately 1 mL/min per year.11 A proportion see more of people with type 2 diabetes show a more rapid decline in GFR, in the absence of microalbuminuria or macroalbuminuria.12 In people with type 2 diabetes and established nephropathy, some but not all longitudinal studies have documented a decline in GFR without
intervention of about 10 mL/min per year.13 In people with type 1 diabetes, and overt kidney disease, the extent of early reduction in AER GNE-0877 by ACEi predicts the degree of protection from subsequent decline in GFR).14 Whether this occurs in people with type 2 diabetes is not yet known. Lack of uniformity in results on decline in GFR in longitudinal studies is in part due to study design, since most studies have focussed on albuminuria and have been too short to document clinically significant changes in GFR. In a Japanese study over 48 months, no change in GFR was demonstrated in 48 patients who were either untreated or treated with nifedipine, enalapril or both drugs.15 In another study of 103 normotensive Indians over 5 years, there was no change in GFR during treatment with placebo or enalapril.16 By contrast, two studies have shown a significant decline in GFR in at least one study arm. In a 5 year study of 94 middle aged normotensive Israelis, GFR remained stable in those treated with enalapril but declined in those treated with placebo.17 This study used the inverse of the serum creatinine level as an index of GFR. In a 3-year study of 18 hypertensive Italians, the GFR (measured isotopicaly) decreased in those treated with cilazapril or amlodipine.