title: Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes.
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.
  
  
  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.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan. araki@belle.shiga-med.ac.jp
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Araki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Koya
authors.forename: Hideki
authors.initials: H
authors.lastname: Hidaka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Motohide
authors.initials: M
authors.lastname: Isono
authors.forename: Keiji
authors.initials: K
authors.lastname: Isshiki
authors.forename: Masami
authors.initials: M
authors.lastname: Chin-Kanasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Uzu
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kashiwagi
mesh_terms: 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
chemical_list: D006442:Glycated Hemoglobin