title: Risk of progression of nephropathy in a population-based sample with type 2 diabetes.
abstract: OBJECTIVE
  Progression through stages of nephropathy has not been well described in a large, well-characterized, population-based study. Our aims were to describe the progression of nephropathy and identify characteristics associated with progression in a U.S. population-based sample.
  
  
  METHODS
  We identified 10,290 members of a managed care organization who had hypertension and type 2 diabetes, a urine albumin-to-creatinine ratio (UACR) measurement in 2001-2003, and at least 2 follow-up UACRs. Progression of nephropathy was defined as progression to a higher stage of nephropathy than was present at baseline.
  
  
  RESULTS
  At baseline, 57% had normoalbuminuria, 31% had microalbuminuria, and 12% had macroalbuminuria. The incidence of nephropathy progression (per 1000 person-years) was 94.7, 35.1, and 6.5 for normo-, micro-, and macro-albuminuria, respectively. ACEi/ARB use ranged from 61-67%, except among patients with macroalbuminuria at follow-up. Age, diabetes duration, and A1C were significant predictors of progression.
  
  
  CONCLUSIONS
  Our study, one of the first to examine the progression of nephropathy in a U.S. population-based sample, showed that among adults with diabetes and hypertension, the burden of nephropathy and its progression may be greater than previously reported. Further, the use of ACEi/ARBs was not optimal.
authors.affiliation: The Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, GA 30305, United States. suma.vupputuri@kp.org
authors.forename: S
authors.initials: S
authors.lastname: Vupputuri
authors.forename: G A
authors.initials: GA
authors.lastname: Nichols
authors.forename: H
authors.initials: H
authors.lastname: Lau
authors.forename: P
authors.initials: P
authors.lastname: Joski
authors.forename: M L
authors.initials: ML
authors.lastname: Thorp
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged