A simplified approach to renal and cardiovascular protection for Australian Aboriginal people with Type 2 Diabetes

Kondalsamy, Chennakesavan and Hoy, W. E. (2004). A simplified approach to renal and cardiovascular protection for Australian Aboriginal people with Type 2 Diabetes. In: Nephrology: 40th Annual Scientific Meeting of the Australian & New Zealand Society of Nephrology. 40th Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology, Adelaide Convention Centre, Adelaide, Australia, (A8-A8). 1–3 September, 2004.


Author Kondalsamy, Chennakesavan
Hoy, W. E.
Title of paper A simplified approach to renal and cardiovascular protection for Australian Aboriginal people with Type 2 Diabetes
Conference name 40th Annual Scientific Meeting of the Australian and New Zealand Society of Nephrology
Conference location Adelaide Convention Centre, Adelaide, Australia
Conference dates 1–3 September, 2004
Proceedings title Nephrology: 40th Annual Scientific Meeting of the Australian & New Zealand Society of Nephrology   Check publisher's open access policy
Place of Publication Carlton, Vic. Australia
Publisher Blackwell Science
Publication Year 2004
ISSN 1320-5358
1440-1797
Volume 9
Issue Supp. 1
Start page A8
End page A8
Total pages 1
Language eng
Abstract/Summary Recommendations vary for renal and cardiovascular-protective treatment for type 2 diabetics with ACEi and/or ARBs – when to start, the dose and treatment goals. The HOPE study recommends maximum dose ACEi for all diabetics with any additional risk factor, including overweight (micro)albuminuria, high blood pressure, cigarette smoking, high cholesterol and coexisting cardiovascular disease. Other studies report little benefit with low dose ACEi, and that full dose is generally well tolerated, safe and effective, even with advanced renal insufficiency. We examined implications for Aboriginal people in remote areas, where health services are stretched, doctor visits few, and chronic disease care flows best where Health Workers can follow simple algorithms, use a limited menu of drugs, and start treatment immediately. We analysed profiles of diabetics four remote areas, shown below, with hypertension defined at ≥ 140/90 & at ≥ 130/85, in parentheses. Nearly all had additional ‘risk factors’, even with cholesterol levels and CV disease excluded. The few without will probably acquire them with age. We recommend universal ACEi/ARB treatment for diabetics, where no contraindications exist, and titration to full dose at one month for everyone without side-effects and with acceptable potassium and creatinine levels. Combination and additional therapy can then be used for BP still not at goal, which also needs to be specified uniformly. This simplifies the renal and CV-protective elements of treatment, eliminates uncertainty, reduces follow up visits, and minimises implications of failing to detect additional risk factors or complications later in their course.
Subjects 110312 Nephrology and Urology
1103 Clinical Sciences
Keyword Renal disease
Indigenous Australians
Hypertension
Type 2 diabetes
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

 
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Created: Wed, 17 Mar 2010, 10:24:19 EST by Therese Egan on behalf of Faculty Of Health Sciences