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Progression to overt nephropathy in type 2 diabetes: the Casale Monferrato Study.
Diabetes Care 2003; 26(7):2150-5DC

Abstract

OBJECTIVE

The first sign of diabetic nephropathy is microalbuminuria, but its predictive role of progression to overt nephropathy in type 2 diabetes has not yet been clarified. The aims of this study were to assess during 7 years of follow-up the incidence rate of overt nephropathy and the predictive role of microalbuminuria and other baseline variables (blood pressure, lipids, fibrinogen, uric acid, smoking, and HbA(1c) cumulative average during follow-up).

RESEARCH DESIGN AND METHODS

A prospective population-based study was performed in Casale Monferrato, Italy, including 1,253 type 2 diabetic patients recruited at baseline (1991-1992), 765 with normoalbuminuria (albumin excretion rate [AER] <20 microg/min) and 488 with microalbuminuria (AER 20-200 microg/min). All measurements were centralized. A nested case-control study within the cohort was performed, selecting four control subjects, frequency matched for age and attained individual time of follow-up with each case. Conditional regression analysis was performed to assess variables independently associated with risk of progression to overt nephropathy.

RESULTS

Of 1,253 total patients, 1,103 (88.0%) were included in the follow-up examination (median 5.33 years); their age and duration of disease at baseline were 68.4 +/- 10.5 years and 10.4 +/- 6.6 years, respectively. Cases of overt nephropathy were 202, giving an incidence rate of 37.0/1,000 person-years (95% CI 32.3-42.6). In conditional logistic regression analyses, microalbuminuria provided a 42% increased risk with respect to normoalbuminuria (95% CI 0.98-2.06), independently of duration of diabetes, hypertension, and systolic blood pressure. Other variables independently associated with progression to overt nephropathy were HbA(1c) cumulative average (P = 0.002), apolipoprotein B (P = 0.013), fibrinogen (P = 0.02), and HDL cholesterol (P = 0.03).

CONCLUSIONS

Of type 2 diabetic patients, 3.7% progress every year to overt nephropathy. Microalbuminuria is associated with a 42% increased risk of progression to overt nephropathy. Other independent predictors are HbA(1c), HDL cholesterol, apolipoprotein B, and fibrinogen.

Authors+Show Affiliations

Department of Internal Medicine, Turin University, Turin, Italy. graziella.bruno@katamail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12832328

Citation

Bruno, Graziella, et al. "Progression to Overt Nephropathy in Type 2 Diabetes: the Casale Monferrato Study." Diabetes Care, vol. 26, no. 7, 2003, pp. 2150-5.
Bruno G, Merletti F, Biggeri A, et al. Progression to overt nephropathy in type 2 diabetes: the Casale Monferrato Study. Diabetes Care. 2003;26(7):2150-5.
Bruno, G., Merletti, F., Biggeri, A., Bargero, G., Ferrero, S., Pagano, G., & Cavallo Perin, P. (2003). Progression to overt nephropathy in type 2 diabetes: the Casale Monferrato Study. Diabetes Care, 26(7), pp. 2150-5.
Bruno G, et al. Progression to Overt Nephropathy in Type 2 Diabetes: the Casale Monferrato Study. Diabetes Care. 2003;26(7):2150-5. PubMed PMID: 12832328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progression to overt nephropathy in type 2 diabetes: the Casale Monferrato Study. AU - Bruno,Graziella, AU - Merletti,Franco, AU - Biggeri,Annibale, AU - Bargero,Giuseppe, AU - Ferrero,Stefania, AU - Pagano,Gianfranco, AU - Cavallo Perin,Paolo, AU - ,, PY - 2003/7/2/pubmed PY - 2004/3/31/medline PY - 2003/7/2/entrez SP - 2150 EP - 5 JF - Diabetes care JO - Diabetes Care VL - 26 IS - 7 N2 - OBJECTIVE: The first sign of diabetic nephropathy is microalbuminuria, but its predictive role of progression to overt nephropathy in type 2 diabetes has not yet been clarified. The aims of this study were to assess during 7 years of follow-up the incidence rate of overt nephropathy and the predictive role of microalbuminuria and other baseline variables (blood pressure, lipids, fibrinogen, uric acid, smoking, and HbA(1c) cumulative average during follow-up). RESEARCH DESIGN AND METHODS: A prospective population-based study was performed in Casale Monferrato, Italy, including 1,253 type 2 diabetic patients recruited at baseline (1991-1992), 765 with normoalbuminuria (albumin excretion rate [AER] <20 microg/min) and 488 with microalbuminuria (AER 20-200 microg/min). All measurements were centralized. A nested case-control study within the cohort was performed, selecting four control subjects, frequency matched for age and attained individual time of follow-up with each case. Conditional regression analysis was performed to assess variables independently associated with risk of progression to overt nephropathy. RESULTS: Of 1,253 total patients, 1,103 (88.0%) were included in the follow-up examination (median 5.33 years); their age and duration of disease at baseline were 68.4 +/- 10.5 years and 10.4 +/- 6.6 years, respectively. Cases of overt nephropathy were 202, giving an incidence rate of 37.0/1,000 person-years (95% CI 32.3-42.6). In conditional logistic regression analyses, microalbuminuria provided a 42% increased risk with respect to normoalbuminuria (95% CI 0.98-2.06), independently of duration of diabetes, hypertension, and systolic blood pressure. Other variables independently associated with progression to overt nephropathy were HbA(1c) cumulative average (P = 0.002), apolipoprotein B (P = 0.013), fibrinogen (P = 0.02), and HDL cholesterol (P = 0.03). CONCLUSIONS: Of type 2 diabetic patients, 3.7% progress every year to overt nephropathy. Microalbuminuria is associated with a 42% increased risk of progression to overt nephropathy. Other independent predictors are HbA(1c), HDL cholesterol, apolipoprotein B, and fibrinogen. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/12832328/Progression_to_overt_nephropathy_in_type_2_diabetes:_the_Casale_Monferrato_Study_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=12832328 DB - PRIME DP - Unbound Medicine ER -