Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes.
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.


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.
Araki
Shin-ichi
S
Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan. araki@belle.shiga-med.ac.jp
Haneda
Masakazu
M
Koya
Daisuke
D
Hidaka
Hideki
H
Sugimoto
Toshiro
T
Isono
Motohide
M
Isshiki
Keiji
K
Chin-Kanasaki
Masami
M
Uzu
Takashi
T
Kashiwagi
Atsunori
A
D000368:Aged; D000419:Albuminuria / Q000503:physiopathology / Q000517:prevention & control*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D040242:Risk Reduction Behavior; D016019:Survival Analysis
D006442:Glycated Hemoglobin