title: Gestational diabetes mellitus alone in the absence of subsequent diabetes is associated with microalbuminuria: results from the Kidney Early Evaluation Program (KEEP).
abstract: OBJECTIVE
  Women with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.
  
  
  METHODS
  This cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1-2 and 3-5 was assessed using logistic regression.
  
  
  RESULTS
  Of 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1-2 (multivariate odds ratio 1.54 [95% CI 1.16-2.05]) similar to the odds for women with overt diabetes (1.68 [1.55-1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1-2 but not CKD stages 3-5 among women with GDM.
  
  
  CONCLUSIONS
  Women with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1-2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York, USA. asb68@columbia.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rekhtman
authors.forename: Adam T
authors.initials: AT
authors.lastname: Whaley-Connell
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.forename: James R
authors.initials: JR
authors.lastname: Sowers
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000209:etiology*; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy
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