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Regression of microalbuminuria in type 1 diabetes.

Abstract

BACKGROUND

In the present study, we aimed to determine the frequency of a significant reduction in urinary albumin excretion and factors affecting such reduction in patients with type 1 diabetes and microalbuminuria.

METHODS

The study included 386 patients with persistent microalbuminuria, indicated by repeated measurements of urinary albumin excretion (estimated on the basis of albumin-to-creatinine ratios) in the range of 30 to 299 microg per minute during an initial two-year evaluation period. Subsequent measurements during the next six years were grouped into two-year periods, averaged, and analyzed for regression of microalbuminuria, which was defined as a 50 percent reduction in urinary albumin excretion from one two-year period to the next.

RESULTS

Regression of microalbuminuria was frequent, with a six-year cumulative incidence of 58 percent (95 percent confidence interval, 52 to 64 percent). The use of angiotensin-converting-enzyme inhibitors was not associated with the regression of microalbuminuria. However, microalbuminuria of short duration, salutary levels of glycosylated hemoglobin (less than 8 percent), low systolic blood pressure (less than 115 mm Hg), and low levels of both cholesterol and triglycerides (less than 198 mg per deciliter [5.12 mmol per liter] and 145 mg per deciliter [1.64 mmol per liter], respectively) were independently associated with the regression of microalbuminuria. Patients with salutary levels of all modifiable factors had a hazard ratio for regression of 3.0 (95 percent confidence interval, 1.5 to 6.0), as compared with patients with no salutary levels of any modifiable factor.

CONCLUSIONS

Frequent regression of microalbuminuria in patients with type 1 diabetes indicates that elevated urinary albumin excretion does not imply inexorably progressive nephropathy. Identification of the multiple determinants of the regression of microalbuminuria has implications for current theories about the mechanisms of early diabetic nephropathy.

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  • Authors+Show Affiliations

    ,

    Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, MA 02215, USA.

    , , , ,

    Source

    The New England journal of medicine 348:23 2003 Jun 05 pg 2285-93

    MeSH

    Adolescent
    Adult
    Albuminuria
    Analysis of Variance
    Case-Control Studies
    Diabetes Mellitus, Type 1
    Diabetic Nephropathies
    Female
    Follow-Up Studies
    Humans
    Male
    Proportional Hazards Models
    Prospective Studies
    Regression Analysis
    Remission, Spontaneous

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12788992

    Citation

    Perkins, Bruce A., et al. "Regression of Microalbuminuria in Type 1 Diabetes." The New England Journal of Medicine, vol. 348, no. 23, 2003, pp. 2285-93.
    Perkins BA, Ficociello LH, Silva KH, et al. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003;348(23):2285-93.
    Perkins, B. A., Ficociello, L. H., Silva, K. H., Finkelstein, D. M., Warram, J. H., & Krolewski, A. S. (2003). Regression of microalbuminuria in type 1 diabetes. The New England Journal of Medicine, 348(23), pp. 2285-93.
    Perkins BA, et al. Regression of Microalbuminuria in Type 1 Diabetes. N Engl J Med. 2003 Jun 5;348(23):2285-93. PubMed PMID: 12788992.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Regression of microalbuminuria in type 1 diabetes. AU - Perkins,Bruce A, AU - Ficociello,Linda H, AU - Silva,Kristen H, AU - Finkelstein,Dianne M, AU - Warram,James H, AU - Krolewski,Andrzej S, PY - 2003/6/6/pubmed PY - 2003/6/11/medline PY - 2003/6/6/entrez SP - 2285 EP - 93 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 348 IS - 23 N2 - BACKGROUND: In the present study, we aimed to determine the frequency of a significant reduction in urinary albumin excretion and factors affecting such reduction in patients with type 1 diabetes and microalbuminuria. METHODS: The study included 386 patients with persistent microalbuminuria, indicated by repeated measurements of urinary albumin excretion (estimated on the basis of albumin-to-creatinine ratios) in the range of 30 to 299 microg per minute during an initial two-year evaluation period. Subsequent measurements during the next six years were grouped into two-year periods, averaged, and analyzed for regression of microalbuminuria, which was defined as a 50 percent reduction in urinary albumin excretion from one two-year period to the next. RESULTS: Regression of microalbuminuria was frequent, with a six-year cumulative incidence of 58 percent (95 percent confidence interval, 52 to 64 percent). The use of angiotensin-converting-enzyme inhibitors was not associated with the regression of microalbuminuria. However, microalbuminuria of short duration, salutary levels of glycosylated hemoglobin (less than 8 percent), low systolic blood pressure (less than 115 mm Hg), and low levels of both cholesterol and triglycerides (less than 198 mg per deciliter [5.12 mmol per liter] and 145 mg per deciliter [1.64 mmol per liter], respectively) were independently associated with the regression of microalbuminuria. Patients with salutary levels of all modifiable factors had a hazard ratio for regression of 3.0 (95 percent confidence interval, 1.5 to 6.0), as compared with patients with no salutary levels of any modifiable factor. CONCLUSIONS: Frequent regression of microalbuminuria in patients with type 1 diabetes indicates that elevated urinary albumin excretion does not imply inexorably progressive nephropathy. Identification of the multiple determinants of the regression of microalbuminuria has implications for current theories about the mechanisms of early diabetic nephropathy. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12788992/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa021835?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -