Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM.

Forsblom, Carol; Groop, Per Henrik; Ekstrand, Agneta; Tötterman, K. J.; Sane, Timo; Saloranta, Carola; Groop, Leif

doi:10.2337/diacare.21.11.1932

Cited by 92 publications

(69 citation statements)

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“…Moreover, given their increased risk of progression, patients with persistent MA should be considered for antihypertensive therapy and improved glycemic control. However, concerns have been previously raised (39,51,91), and this study concurs, that AER does not predict DN risk with the accuracy suggested by the original studies in this field (7)(8)(9) and that changes in the natural history of this disease may not fully explain these discrepancies. Moreover, AER as a predictor in nonproteinuric diabetic patients may not be sufficient for optimal clinical decision making, clinical research design, or public health policy development.…”

Section: Discussionsupporting

confidence: 47%

“…These additional variables could include age, diabetes duration, blood pressure (including 24-h blood pressure monitoring), GFR, HbA 1c , retinopathy, and renal biopsy measurements. Prospective studies in type 1 and type 2 diabetic patients generally support the concept that normoalbuminuric and MA patients who progress have significantly higher baseline levels of blood pressure (25,39,43,44,47,(75)(76)(77) and HbA 1c (14,21,22,25,39,40,(43)(44)(45)47,(77)(78)(79) compared with patients that do not progress. However, there is still controversy as to whether increased baseline GFR is a predictor of progression (9,24,(80)(81)(82)(83)(84)(85).…”

Section: Need For New Markers and Predictors Of Diabetic Nephropathy mentioning

confidence: 97%

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The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient?

2000

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Initial studies showing an ~80% rate of progression from microalbuminuria (MA) to proteinuria in type 1 diabetic patients led to the broad acceptance of MA as a useful clinical predictor of increased diabetic nephropathy (DN) risk. Some MA patients, however, have quite advanced renal structural changes, and MA may, in these cases, be a marker rather than a predictor of DN. More recent studies have observed only about a 30-45% risk of progression of MA to proteinuria over 10 years, while about 30% of type 1 diabetic patients with MA became normoalbuminuric and the rest remained microalbuminuric. The finding that some MA patients have only mild diabetic renal lesions is consistent with the lower than originally estimated risk of progression from MA to proteinuria and with the notion that some MA patients revert to normoalbuminuria. To increase the complexity of the scenario, some normoalbuminuric long-standing type 1 diabetic patients have well-established DN lesions and ~40% of all patients destined to progress to proteinuria are normoalbuminuric at initial screening, despite many years of diabetes. A similar picture is emerging in type 2 diabetic patients, although fewer studies have been conducted. Thus, the predictive precision for MA to progress to overt nephropathy over the subsequent decade or so is considerably less than originally described. It is unclear whether this is due to changes in the natural history of DN resulting from improved glycemia and blood pressure control, or whether there were overestimates of risk in the original studies due to the small sample sizes, post hoc analyses, and variable MA definitions. Albumin excretion rate (AER) remains the best available noninvasive predictor of DN risk and should be regularly measured according to established guidelines. However, AER may be unable to define patients who are safe from or at risk of DN with an accuracy that is adequate for optimal clinical decision making or for the design of certain clinical trials. Investigations into new risk markers or into the combined use of several currently available predictive parameters are needed.

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Section: Discussionsupporting

confidence: 47%

Section: Need For New Markers and Predictors Of Diabetic Nephropathy mentioning

confidence: 97%

The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient?

2000

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“…This is consistent with findings from a prospective study in a population with older-onset type 2 diabetes 35 . In contrast, history of smoking, rather than current smoking, was found to be associated with microalbuminuria in one study of 108 patients with type 2 diabetes 34 but not in another study of 191 patients with type 2 diabetes 12 .…”

Section: Discussionmentioning

confidence: 91%

A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Lee

Devereux

et al. 2008

American Journal of Kidney Diseases

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“…[7][8][9][10][11] BP is a major predictor of microalbuminuria in people with diabetes. 7,[12][13][14][15] Patients with type 2 diabetes are usually diagnosed with hypertension in the office before microalbuminuria is detected, 16 and it is not clear whether ambulatory monitoring adds useful information to the assessment of BP in these patients. Previous studies of ABP in subjects with type 2 diabetes have been limited by small sample sizes or lack of office BP measurements.…”

mentioning

confidence: 99%

Office and Ambulatory Blood Pressure Are Independently Associated With Albuminuria in Older Subjects With Type 2 Diabetes

et al. 2006

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Abstract-Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes.Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (PϽ0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.

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Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM.

Abstract: This study reemphasizes the importance of poor glycemic control and smoking as independent risk factors for progression of AER. Furthermore, development of micro- or macroalbuminuria in NIDDM was associated with neuropathy and male sex.

Cited by 92 publications

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The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient?

The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient?

A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Office and Ambulatory Blood Pressure Are Independently Associated With Albuminuria in Older Subjects With Type 2 Diabetes

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