Association Between Blood Pressure and Adverse Renal Events in Type 1 Diabetes.

ObjectiveTo compare different blood pressure (BP) levels in their association with the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association.Research design and methodsWe included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate <60 mL/min/1.73 m2).ResultsDuring a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the <120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the <70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P > 0.05).ConclusionsA lower BP (<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes

Ariel - Volume 1 Number 3

Copyright 1969 Arie

Protecting Academic Freedom Through Collective Bargaining: An AAUP Perspective

AAUP’s turn to collective bargaining grew out of a more expansive view of unionization than is typical for American labor unions. The mission of the AAUP incorporates addressing economic matters, as does the purpose of unions generally. But the AAUP adopted collective bargaining as a means of protecting and expanding the professional interests of the profession. This paper surveys the various approaches that AAUP chapters have used to accomplish the safeguarding and expansion of academic freedom

Panel: Shared Governance and Collective Bargaining: The Line Between Protecting Shared Governance Through Collective Bargaining: Models Used by AAUP Chapters

For over five decades following its founding in 1915, the American Association of University Professors (AAUP) carried out its mission outside of the realm of collective bargaining. The organization formulated policy on a constantly evolving range of issues of concern to higher education, and worked to have those policies adopted by individual institutions and state public higher education systems. The mechanisms employed were a combination of: encouraging faculty to use their participation in shared governance to work towards policy adoption; interacting directly—including in the initial formulation of policy pronouncements and in joint endorsements—with organizations representing the interests of administrators and trustees; and carrying out visible “enforcement” activities (primarily investigations leading to censure and sanction.

Panel: Shared Governance and Collective Bargaining: The Line Between Protecting Shared Governance Through Collective Bargaining: Models Used by AAUP Chapters

For over five decades following its founding in 1915, the American Association of University Professors (AAUP) carried out its mission outside of the realm of collective bargaining. The organization formulated policy on a constantly evolving range of issues of concern to higher education, and worked to have those policies adopted by individual institutions and state public higher education systems. The mechanisms employed were a combination of: encouraging faculty to use their participation in shared governance to work towards policy adoption; interacting directly—including in the initial formulation of policy pronouncements and in joint endorsements—with organizations representing the interests of administrators and trustees; and carrying out visible “enforcement” activities (primarily investigations leading to censure and sanction.

Characterization of early disease status in treatment-naive male paediatric patients with Fabry disease enrolled in a randomized clinical trial.

Trial designThis analysis characterizes the degree of early organ involvement in a cohort of oligo-symptomatic untreated young patients with Fabry disease enrolled in an ongoing randomized, open-label, parallel-group, phase 3B clinical trial.MethodsMales aged 5-18 years with complete α-galactosidase A deficiency, without symptoms of major organ damage, were enrolled in a phase 3B trial evaluating two doses of agalsidase beta. Baseline disease characteristics of 31 eligible patients (median age 12 years) were studied, including cellular globotriaosylceramide (GL-3) accumulation in skin (n = 31) and kidney biopsy (n = 6; median age 15 years; range 13-17 years), renal function, and glycolipid levels (plasma, urine).ResultsPlasma and urinary GL-3 levels were abnormal in 25 of 30 and 31 of 31 patients, respectively. Plasma lyso-GL-3 was elevated in all patients. GL-3 accumulation was documented in superficial skin capillary endothelial cells (23/31 patients) and deep vessel endothelial cells (23/29 patients). The mean glomerular filtration rate (GFR), measured by plasma disappearance of iohexol, was 118.1 mL/min/1.73 m(2) (range 90.4-161.0 mL/min/1.73 m(2)) and the median urinary albumin/creatinine ratio was 10 mg/g (range 4.0-27.0 mg/g). On electron microscopy, renal biopsy revealed GL-3 accumulation in all glomerular cell types (podocytes and parietal, endothelial, and mesangial cells), as well as in peritubular capillary and non-capillary endothelial, interstitial, vascular smooth muscle, and distal tubules/collecting duct cells. Lesions indicative of early Fabry arteriopathy and segmental effacement of podocyte foot processes were found in all 6 patients.ConclusionsThese data reveal that in this small cohort of children with Fabry disease, histological evidence of GL-3 accumulation, and cellular and vascular injury are present in renal tissues at very early stages of the disease, and are noted before onset of microalbuminuria and development of clinically significant renal events (e.g. reduced GFR). These data give additional support to the consideration of early initiation of enzyme replacement therapy, potentially improving long-term outcome.Trial registrationClinicalTrials.gov NCT00701415