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Master Thesis

La normoalbuminurie prédit un meilleur pronostic cardiovasculaire à 8 ans, dans le diabète de type 1, avec insuffisance rénale légère à modérée

Abstract : Objective. Diabetic kidney disease (DKD) predicts a high cardiovascular morbimortality in type 1 diabetes. Normoalbuminuric DKD is now recognized, but its cardiovascular prognosis has not been fully investigated. We aimed to assess the risk of cardiovascular events and all-cause mortality related to albumin excretion rate (AER) and use of Renin Angiotensin Aldosterone System inhibitors (iRAAS) in type 1 diabetes. Research design and Methods. From the first January 2009 to 31 December 2017, we followed 117 subjects with type 1 diabetes and estimated Glomerular Filtration Rates (eGFR) ranged from 30 to 89 mL/min/1.73m2. Participants were categorized as having “elevated AER”, “normal AER with iRAAS”, and “normal AER without iRAAS”. The main endpoint was a composite of major cardiovascular events or all-cause death. Results. Forty-nine (42%) participants had normal AER without iRAAS. Compared with others, they were mostly women, younger, with a shorter diabetes duration, lower BMI and plasma triglycerides, a higher eGFR, and less common diabetic retinopathy and macroangiopathy. The endpoint occurred in 9 (43%), 14 (30%), and 3 (6%) participants with elevated AER, normal AER/iRAAS+, and normal AER/iRAAS-, respectively (p=0.0008). The risk of endpoint was significantly lower in participants with normal AER/iRAAS- compared to those with elevated AER (HR 0.20 95%CI [0.04-0.76], p=0.02) after adjustment for cofounding variables. No evidence for interaction was observed between eGFR and AER on their association with the endpoint (p=0.46). Conclusions. Normoalbuminuria without iRAAS is less prone to death and major cardiovascular events in subjects with type 1 diabetes and mild-moderately impaired renal function.
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https://dumas.ccsd.cnrs.fr/dumas-02438424
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Marie Monlun-Ribes. La normoalbuminurie prédit un meilleur pronostic cardiovasculaire à 8 ans, dans le diabète de type 1, avec insuffisance rénale légère à modérée. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02438424⟩

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