Regression of Microalbuminuria in Type 1 Diabetes

Perkins, Bruce A.; Ficociello, Linda H.; Silva, Kristen H.; Finkelstein, Dianne M.; Warram, James H.; Królewski, Andrzej S.

doi:10.1056/nejmoa021835

Cited by 712 publications

(561 citation statements)

References 44 publications

(32 reference statements)

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“…In a recent 6-year follow-up analysis of Type 1 diabetic patients with AER levels between 30 and 299 µg/min at base-line, regression of microalbuminuria was defined both as an absolute AER value of less than 30 µg/min, and as a 50% reduction of AER. This was done to make the estimate independent of the AER lower threshold [24]. Both assessments gave a similar cumulative proportion of patients reverting to normoalbuminuria (59% and 58% respectively, for the 6-year interval), which is similar to the proportion found in this study (50.6% in 7 years).…”

Section: Discussionsupporting

confidence: 73%

“…Secondly, a valid AER estimation was obtained in 63.5% of potentially available patients (352/554). Although prospective studies carried out in single centres have a higher follow-up rate [22,23], the proportion of patients completing the follow-up tends to decrease with time when large groups of patients are recruited [24], and this is particularly true given the broad European scope of the EURODIAB multicentre study. Patients not available at follow-up had worse metabolic control, as indicated by higher HbA 1 c and triglyceride concentrations.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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“…Associations between reduction of urinary albumin and dyslipidemia were reported in a cohort study of 386 patients with type 1 diabetes [26]. In this study, along with low levels of glycosylated hemoglobin and low systolic blood pressure, low levels of both cholesterol and triglycerides were independently associated with regression of microalbuminuria.…”

Section: Relationships Between Dyslipidemia and Progression Or Regressupporting

confidence: 60%

Treatment and impact of dyslipidemia in diabetic nephropathy

et al. 2013

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Recent epidemiological research revealed that dyslipidemia is a risk factor for development and progression of diabetic nephropathy. Results from interventional studies revealed the possibility that antihyperlipidemic agents have a better effect on diabetic nephropathy through improvement of albuminuria and loss of renal function. In addition, dyslipidemia may be a consequence of albuminuria and renal dysfunction, thereby perpetuating kidney damage. Today, the proportion of diabetic patients receiving statins is increasing due to their beneficial effect on cardiovascular mortality. However, treatment for patients should be determined based on consideration of the risk and benefit of the treatment. More insight into the pathogenesis of diabetic nephropathy and the effects of life-style changes is required.

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“…Regression of the earlier stages of microalbuminuria has been demonstrated following antihypertensive treatment, and one prospective observational study reported that, over a 7.5-year follow-up period, regression occurred in 35% of 79 type 1 patients with microalbuminuria (in 39% of patients treated with an ACE inhibitor and in 13% of untreated patients). In another study, a reduction (>50%) in the urinary AER was observed in 58% of 386 microalbuminuric type 1 diabetic patients, but this reduction was transient in many patients, the follow-up period was shorter and the drop-out rate was 47% [30].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 92%

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Rossing

2005

Diabetologia

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Diabetic microvascular complications in the kidney and the eye are a major burden for diabetic patients due to increased morbidity and mortality. Furthermore, diabetic nephropathy is the leading cause of end-stage renal disease and diabetic retinopathy is the leading cause of blindness in younger patients, representing a major public health concern. During the past two decades beneficial effects of, in particular, aggressive antihypertensive control and strict glycaemic control have been demonstrated in randomised controlled clinical trials. Technological improvements in diabetes care have made good metabolic control easier to achieve. Has this led to an improved prognosis? In observational studies from dedicated centres, a decrease from 47 to 13% has been reported in the incidence of proliferative diabetic retinopathy after 20-25 years of diabetes, and the incidence of overt diabetic nephropathy after 20 years has decreased from 28 to 5.8%. Even functional and morphological remission of diabetic nephropathy has been reported. Despite this, recent population-based studies have failed to demonstrate a decrease in the incidence of blindness caused by diabetes, and the incidence of end-stage renal disease has progressively increased. This may, in part, be the result of a combination of increasing numbers of diabetic patients and a lag phase between improvement in management and a decline in end-stage complications. It is of concern, however, that the results from specialised centres may not apply to routine diabetes care. It is, therefore, mandatory that the beneficial effects of pharmacological and non-pharmacological interventions demonstrated in clinical trials and recommended by treatment guidelines are translated into clinical practice to ensure a widespread improvement in prognosis.

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Regression of Microalbuminuria in Type 1 Diabetes

Cited by 712 publications

References 44 publications

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Treatment and impact of dyslipidemia in diabetic nephropathy

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

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