Determinants of progression from microalbuminuria to proteinuria in patients who have type 1 diabetes and are treated with angiotensin-converting enzyme inhibitors.
The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 mug/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear.
Ficociello
Linda H
LH
Research Division, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
Perkins
Bruce A
BA
Silva
Kristen H
KH
Finkelstein
Dianne M
DM
Ignatowska-Switalska
Halina
H
Gaciong
Zbigniew
Z
Cupples
L Adrienne
LA
Aschengrau
Ann
A
Warram
James H
JH
Krolewski
Andrzej S
AS
D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D011507:Proteinuria / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D001786:Blood Glucose; D002784:Cholesterol; D007703:Peptidyl-Dipeptidase A