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Medicines for Early Stage Chronic Kidney Disease: A Review of the Research for Adults With Kidney Disease and Diabetes or High Blood Pressure

This summary will tell you about medicines for people with early stage chronic kidney disease and diabetes, high blood pressure, high cholesterol, or heart or blood vessel diseases. It will explain what research says about the benefits and possible side effects of these medicines. It can help you talk with your doctor about whether or not one of these medicines may be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: October 11, 2012

Zinc supplementation for the prevention of type 2 diabetes mellitus

Currently no evidence to suggest the use of zinc for the primary prevention of type 2 diabetes. Diabetes mellitus is associated with long‐term complications, especially eye, kidney, nerve, heart and blood vessel disease. Type 2 diabetes is mainly characterised by a reduced ability of the hormone insulin to stimulate glucose uptake in body fat and muscles (insulin resistance) and affects most people suffering from diabetes. Type 2 diabetes may not cause symptoms for some time and may remain undetected for many years. Zinc, an important mineral, plays a relevant role in the synthesis and action of insulin. The human body does not produce zinc on its own, so it must be obtained from outside sources. The mineral zinc can be found in both animal and plant food sources, but the richest source of zinc comes from animal food sources.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Hormone replacement therapy for women with type 1 diabetes mellitus

There are increasing numbers of people living with type 1 diabetes mellitus. The main aim of treatment for diabetes is to maintain good quality of life and to minimise, or prevent, the development of diabetic complications by controlling blood glucose levels. Women with type 1 diabetes frequently express difficulties in controlling their blood glucose levels during the menopausal phase of their lives. However, the cause of this has not been explored.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Cinnamon for diabetes mellitus

Diabetes mellitus is a chronic metabolic disorder. People with diabetes are known to be at greater risk of cardiovascular disease (including heart attack, stroke, and peripheral vascular disease such as acute or chronic ischaemia of a leg resulting in severe pain when walking short distances). There is also an increased risk of eye disease, kidney failure, nerve damage and sexual dysfunction when compared to the general population. Improvements in the regulation of blood sugar levels may help to reduce the risk of these complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Colesevelam for type 2 diabetes mellitus

Colesevelam was originally approved for the treatment of hyperlipidaemia (high blood lipids) in the 2000s but has been shown to improve blood sugar as well. Therefore, we investigated its role in the management of type 2 diabetes mellitus. A total of 1450 patients took part in six studies investigating colesevelam. These studies lasted 8 to 26 weeks. Only one small study compared colesevelam directly to placebo, the other five studies investigated a combination of colesevelam with other antidiabetic agents versus a combination of placebo with other antidiabetic agents. There were no two studies with the same intervention and comparison group. When added to other antidiabetic agents colesevelam showed improvements in the control of blood glucose and blood lipids. However, it is difficult to disentangle the effects of colesevelam from the other antidiabetic agents used because only one study compared colesevelam to placebo. The same is true for adverse effects: three studies reported on just a few non‐severe hypoglycaemic episodes, no other serious side effects were observed. No study investigated mortality; complications of type 2 diabetes such as eye disease, kidney disease, heart attack and stroke; health‐related quality of life; functional outcomes and costs of treatment. Therefore, long‐term data on the efficacy and safety of colesevelam are necessary.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Targeting intensive glycaemic control versus targeting conventional glycaemic control for people with type 2 diabetes mellitus

People with type 2 diabetes mellitus (T2D) have an increased mortality and morbidity compared to the general population. T2D is characterised by several metabolic defects including impaired insulin secretion and action, causing chronic hyperglycaemia (high glucose levels in the blood). Chronic hyperglycaemia is strongly associated with increased risk of kidney, eye, and nerve complications (microvascular complications) as well as increased risk of stroke, heart disease, and amputations (macrovascular complications). Epidemiological studies suggest that reducing blood glucose in people with T2D may reduce the risk of death and morbidity. However, such studies do not represent a reliable methodology to assess the effects of interventions because of the inherent risk of imbalances (which may be hidden and therefore uncorrectable) between groups, other than those resulting from the interventions. It is still not clear whether targeting more intensive glycaemic control is better than conventional glycaemic control in terms of clinical outcomes based on evidence from randomised clinical trials (RCTs).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus

The primary objective of this review was to assess the positive and negative outcomes of tighter blood glucose control ('intensive' glucose control) compared to less intense treatment targets ('conventional' glucose control) in individuals with type 1 diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Drugs for preventing kidney disease in people with diabetes

Many people with diabetes (around 20% to 60%) are are affected by high blood pressure (hypertension) and need drugs (antihypertensive agents) to treat this condition. These drugs also help to prevent development of kidney disease both in people with diabetes who have normal blood pressure and those whose blood pressure is high. Many people with diabetic kidney disease (DKD) (20% to 40%) go on to develop end‐stage kidney disease (ESKD), and many others die from heart disease or other circulatory problems before ESKD develops.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers for adults with early chronic kidney disease who do not have diabetes

Chronic kidney disease (CKD) is a long‐term condition that occurs as a result of the kidneys being damaged. Progressive deterioration of kidney function can lead to end‐stage kidney disease (ESKD). People with ESKD cannot maintain healthy kidney function and need kidney dialysis or transplant. In the early stages of CKD, patients may not have any outward symptoms or signs of illness, and may only be detected following investigations such as urine or blood testing. Two types of drugs ‐ angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) ‐ have been widely recommended in clinical guidelines for doctors to use in the management of CKD. This review identified four studies (enrolling 2177 people). Three studies compared ACEi to placebo or no treatment and one study compared ACEi to ARB. There is not enough evidence in the published literature at present to determine how effective drugs in the ACEi or ARB families are for treating patients with early (stage 1 to 3) CKD who do not have diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Type 2 diabetes: Does self-monitoring urine and blood glucose levels have benefits for people who do not inject insulin?

Regular self-monitoring of glucose levels has not been proven to have benefits for people with type 2 diabetes who do not inject insulin. It is not known whether self-monitoring can help prevent diabetes-related complications in this group of people.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 23, 2011

Type 2 diabetes: Is it better to lower blood sugar levels to near-normal levels?

People with type 2 diabetes can prevent complications if they lower their high blood sugar levels permanently. Many doctors even recommend trying to get to near-normal blood sugar levels. But trials show that lowering blood sugar to near-normal levels can have both advantages and disadvantages compared with lowering blood sugar levels more moderately.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 24, 2011

Is antioxidant therapy beneficial for people with chronic kidney disease?

People with chronic kidney disease (CKD) have high risk of developing heart disease and dying prematurely. Although heart disease has many causes, damage caused by poor oxygen exchange in the body's cells (oxidative stress) is thought to be a major problem. People with CKD often have evidence of oxidative stress and this is positively associated with the rate of kidney disease progression. We assessed current evidence to evaluate how antioxidant therapy influenced outcomes for patients with CKD. Overall, we found that antioxidant therapy did not reduce the risk of heart disease or death in people with CKD, but that this could vary depending on CKD stage. There was some evidence to suggest that people on dialysis may benefit from antioxidant treatment, and that these therapies could reduce the risk of kidney disease becoming worse. However, these results are based on very limited evidence and further studies are needed to confirm if antioxidant therapy could be of benefit for people with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Early referral to a specialist doctor for people with kidney disease

Some degree of kidney failure affects about 15% to 25% of people and is a silent disease that creeps up on an individual with symptoms and signs developing only very late. When kidney failure becomes end‐stage, life supporting therapy in the form of dialysis or transplantation is the only option available for the patient. This form of therapy is very expensive and highly intrusive into the patients' life. Measures to prevent progression to this terminal stage are of great importance to prevent this catastrophe.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Methods for Delivering Insulin and Monitoring Blood Sugar: A Review of the Research for Children, Teens, and Adults With Diabetes

This summary discusses what research says about different ways to measure blood sugar and take insulin. It describes what researchers know about how each option compares to the others to help you control your blood sugar level.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 4, 2012

Weight-Loss Surgery for Adults With Diabetes or Prediabetes Who Are at the Lower Levels of Obesity: A Review of the Research for Adults With a BMI Between 30 and 35

This summary will cover: Diabetes and prediabetes and how they are treated BMI and how it is measured How the digestive system works What weight-loss surgery is and an overview of three types of weight-loss surgery: adjustable gastric band, sleeve gastrectomy, and gastric bypass Risks for each type of weight-loss surgery What researchers have found about how well weight-loss surgery works to treat diabetes or prediabetes in people with a BMI between 30 and 35

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 13, 2013

Does altering dietary salt intake aid in the prevention and treatment of diabetic kidney disease?

There is strong evidence that our current consumption of salt is a major factor in increasing blood pressure (BP), whether BP levels are normal or raised. Diabetes makes it more likely to develop high BP, which increases the risk of strokes, heart attacks and speeds up the progression of diabetic kidney disease. This review found 13 studies including 254 patients with type 1 and type 2 diabetes. Reducing salt intake by 8.5 g/day lowered BP by 7/3 mm Hg. Public health guidelines recommend reducing dietary salt intake to less than 5‐6 g/day and people with diabetes would benefit from reducing salt in their diet to at least this level.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Prostaglandin E1 for preventing the progression of diabetic kidney disease

Continuous albuminuria (protein in the urine) is the major characteristic of diabetic kidney disease (DKD), which is regarded primary cause of death and poor health in patients with diabetes mellitus, leading to end‐stage‐kidney disease. While blood pressure medication (such as angiotensin‐converting enzyme inhibitors (ACEi), calcium channel blockers and angiotensin‐receptor blockers (ARB)) has been used/recommended for reducing albuminuria and preventing the progression of DKD, the incidence of DKD is still increasing among developed and developing countries. Prostaglandin E1 (PGE1) is a vasodilator agent which is thought to contribute to releasing intraglomerular pressure, increasing kidney blood circulation and reducing albuminuria. This review identified six studies (271 participants) comparing PGE1 with or without ACEi/ARB versus ACEi/ARB, no treatment or Xueshuantong (a Chinese medicinal herb). The results suggest that PGE1 may have a positive effect on DKD by reducing urinary albumin excretion rate (UAER), microalbuminuria and proteinuria. No serious adverse events or allergic responses were reported. All studies were methodologically poor and there is no strong evidence for recommending PGE1 for preventing the progression of DKD as a routine therapeutic measure. More high‐quality research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease

Kidney disease develops in 25% to 40% of diabetic patients, usually 20 to 25 years after the onset of diabetes. Approximately one third of those with diabetic kidney disease (DKD) will progress to end‐stage kidney disease (ESKD) and will require long‐term dialysis or possibly receive a kidney transplant. Many patients however may die from associated coronary artery disease or other cardiovascular causes before the onset of ESKD. Antihypertensive drugs have been shown to not only be of benefit to the heart but to also provide kidney protection by slowing the progression of DKD to ESKD. Two drugs in particular have been considered equally effective for patients with DKD ‐ these are angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (AIIRA). However studies have focused on kidney protection rather than over mortality. The aim of this review was to assess the benefits and harms or ACEI and AIIRA therapy in patients with DKD. Fifty studies (13,215 patients) were identified comparing ACEi to placebo, AIIRA to placebo and ACEi to AIIRA. The risk of death from any cause was not significantly reduced with the use of ACEi versus placebo, AIIRA versus placebo or ACEi versus AIIRA. However when we looked at the studies which used the maximum dose tolerated of ACEi rather than the lower, so‐called renal doses, there was a significant reduction in the risk of death due to any cause. We were unable to determine which drug provides better protection due to the lack of head‐to‐head trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Education programmes for people with diabetic kidney disease

Adherence to complex regimens is often poor in patients with diabetes and chronic kidney disease (DKD). Interventions to enhance adherence require both intensive education and behavioural counselling. This review looked for randomised trials (RCTs) comparing education programmes with other strategies in patients with DKD. Only two studies involving patients with DKD were identified. Although education programmes seemed to have some beneficial effects on improvement of patients' knowledge of diabetes, self‐efficacy, belief changes and self‐management behavioural changes, the small (207) numbers of patients enrolled in the two identified studies and their low methodological quality resulted in cautious assessment. Larger, high‐quality RCTs are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Pentoxifylline for diabetic kidney disease

Kidney disease develops in 25% to 40% of diabetic patients, usually 20 to 25 years after the onset of diabetes. Approximately one third of those with diabetic kidney disease (DKD) will progress to end‐stage kidney disease (ESKD) and will require long‐term dialysis or possibly receive a kidney transplant. Many patients however may die from associated coronary artery disease or other cardiovascular causes before the onset of ESKD. Pentoxifylline has been described as offering properties that may be beneficial for patients with DKD. We reviewed 17 randomised controlled studies, enrolling 991 patients with DKD, which compared pentoxifylline with placebo, routine treatment or antihypertensive drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Medical Encyclopedia

  • Diabetes insipidus
    Diabetes insipidus is an uncommon condition in which the kidneys are unable to prevent the excretion of water.
  • Diabetes
    Diabetes is usually a lifelong (chronic) disease in which there is a high level of sugar in the blood.
  • Chronic kidney disease
    Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body.
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Systematic Reviews in PubMed

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