Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

Author:

Araki Shin-ichi1,Haneda Masakazu2,Koya Daisuke3,Hidaka Hideki4,Sugimoto Toshiro1,Isono Motohide1,Isshiki Keiji1,Chin-Kanasaki Masami1,Uzu Takashi1,Kashiwagi Atsunori1

Affiliation:

1. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

2. Second Department of Medicine, Asahikawa Medical College, Asahikawa, Hokkaido, Japan

3. Division of Endocrinology and Metabolism, Department of Medicine, Kanazawa Medical School, Kahoku-gun, Ishikawa, Japan

4. Medical and Health Care Center, SANYO Electric Group Health Insurance Association, Moriguchi, Osaka, Japan

Abstract

OBJECTIVE—Microalbuminuria in diabetic patients is a predictor for diabetic nephropathy and cardiovascular disease. The aim of this study is to investigate the clinical impact of reducing microalbuminuria in type 2 diabetic patients in an observational follow-up study. RESEARCH DESIGN AND METHODS—We enrolled 216 type 2 diabetic patients with microalbuminuria during an initial 2-year evaluation period and observed them for the next 8 years. Remission and a 50% reduction of microalbuminuria were defined as a shift to normoalbuminuria and a reduction <50% from the initial level of microalbuminuria. The association between reducing microalbuminuria and first occurrence of a renal or cardiovascular event and annual decline rate of estimated glomerular filtration rate (eGFR) was evaluated. RESULTS—Twelve events occurred in 93 patients who attained a 50% reduction of microalbuminuria during the follow-up versus 35 events in 123 patients without a 50% reduction. The cumulative incidence rate of events was significantly lower in patients with a 50% reduction. A pooled logistic regression analysis revealed that the adjusted risk for events in subjects after a 50% reduction was 0.41 (95% CI 0.15–0.96). In addition, the annual decline rate of eGFR in patients with a 50% reduction was significantly slower than in those without such a reduction. The same results were also found in the analysis regarding whether remission occurred. CONCLUSIONS—The present study provides clinical evidence implying that a reduction of microalbuminuria in type 2 diabetic patients is an integrated indicator for renal and cardiovascular risk reduction.

Publisher

American Diabetes Association

Subject

Endocrinology, Diabetes and Metabolism,Internal Medicine

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