Higher levels of urinary albumin excretion within the normal range predict faster decline in glomerular filtration rate in diabetic patients.
OBJECTIVE To assess the relationship between albuminuria, including elevation within the normal range, and decline in glomerular filtration rate (GFR) in diabetic patients. RESEARCH DESIGN AND METHODS A total of 5,449 Japanese diabetic patients were categorized according to sex and urinary albumin-to-creatinine ratio (ACR; <5, 5-9, 10-29, 30-99, 100-299, 300-999, 1,000-2,999, and > or =3,000 mg/g) and followed for at least 5 years. The rate of change in estimated GFR (eGFR) adjusted for age and baseline eGFR was compared among ACR categories. RESULTS A higher baseline ACR predicted a faster decline in eGFR for both sexes. Even within the normal range (<30 mg/g), ACR > or =10 mg/g in women and > or =5 mg/g in men was associated with a significantly greater rate of decline in eGFR relative to subjects with ACR <5 mg/g. CONCLUSIONS Elevated ACR, even within the normal range, is associated with a faster decline in eGFR in diabetic patients.
Division of Nephrology and Hypertension, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. babazono@dmc.twmu.ac.jp
Tetsuya
T
Babazono
Izumi
I
Nyumura
Kiwako
K
Toya
Toshihide
T
Hayashi
Mari
M
Ohta
Kumi
K
Suzuki
Yuka
Y
Kiuchi
Yasuhiko
Y
Iwamoto
D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000378:metabolism*; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000652:urine*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D012016:Reference Values; D012727:Sex Characteristics; D055815:Young Adult
D003404:Creatinine