A longitudinal study of risk factors for incident albuminuria in diabetic American Indians: the Strong Heart Study.
BACKGROUND
There have been no studies that use longitudinal data with more than 2 measurements and methods of longitudinal data analysis to identify risk factors for incident albuminuria over time more effectively.


METHODS
Longitudinal study.


METHODS
A subgroup of participants in the Strong Heart Study, a population-based sample of American Indians, in central Arizona, Oklahoma, and North and South Dakota. Participants with diabetes without albuminuria were followed up for a mean of 4 years.


METHODS
Age, sex, study center, high-density lipoprotein and low-density lipoprotein cholesterol levels, triglyceride level, body mass index, systolic blood pressure, use of antihypertensive medication, smoking, hemoglobin A(1c) level, fasting glucose level, type of diabetes therapy, diabetes duration, plasma creatinine level, and urinary albumin-creatinine ratio (UACR).


METHODS
Albuminuria was defined as UACR of 30 mg/g or greater. Urine creatinine and albumin were measured by using the picric acid method and a sensitive nephelometric technique, respectively.


RESULTS
Of 750 and 568 participants with diabetes without albuminuria and with normal plasma creatinine levels at the first and second examinations, 246 and 132 developed albuminuria by the second and third examinations, respectively. Incident albuminuria was predicted by baseline UACR, fasting glucose level, systolic blood pressure, plasma creatinine level, study center, current smoking, and use of angiotensin-converting enzyme inhibitors and antidiabetic medications. UACR of 10 to 30 mg/g increased the odds of developing albuminuria 2.7-fold compared with UACR less than 5 mg/g.


CONCLUSIONS
Single random morning urine specimen.


CONCLUSIONS
Many risk factors identified for incident albuminuria can be modified. Control of blood pressure and glucose level, smoking cessation, and use of angiotensin-converting enzyme inhibitors may reduce the incidence of albuminuria.
Xu
Jiaqiong
J
Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. sxu@tmhs.org
Lee
Elisa T
ET
Devereux
Richard B
RB
Umans
Jason G
JG
Bella
Jonathan N
JN
Shara
Nawar M
NM
Yeh
Jeunliang
J
Fabsitz
Richard R
RR
Howard
Barbara V
BV
D000368:Aged; D000419:Albuminuria / Q000208:ethnology*; D001786:Blood Glucose / Q000032:analysis; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000652:urine*; D003928:Diabetic Nephropathies / Q000208:ethnology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D003404:Creatinine