title: Association between remission of macroalbuminuria and preservation of renal function in patients with type 2 diabetes with overt proteinuria.
abstract: OBJECTIVE
  Studies on the rate of remission of macroalbuminuria in patients with type 2 diabetes mellitus (T2DM) and the effects of reduction in albuminuria on renal prognosis in a primary care setting are absolutely lacking.
  
  
  METHODS
  A total of 211 T2DM patients with albuminuria≥300 mg/g were enrolled in a prospective observational study (mean of 4.5 years). The incidence of patients with remission of macroalbuminuria at every 1-year study time point after starting intensified diabetes treatment and the factors associated with remission were evaluated. The association of reduction in albuminuria with renal events (doubling of serum creatinine and end-stage renal disease) was also investigated.
  
  
  RESULTS
  During the 5-year study period, remission to microalbuminuria occurred in 116 patients and the 5-year cumulative incidence was 58.3%. Notably, most cases (82.8%) obtained remission at the 1-year study time point. The remission rate increased with achieving therapeutic targets for blood pressure and blood glucose. Remission and reduction in albuminuria of ≥50% were associated with preservation of renal function. In particular, patients who obtained both remission and 50% reduction at the 1-year study time point exhibited a significantly reduced risk for renal events as compared with those with no remission and no reduction (adjusted hazard ratio 0.30 [95% CI 0.12-0.76]).
  
  
  CONCLUSIONS
  Remission of macroalbuminuria occurs frequently and is associated with the preservation of renal function in T2DM patients. The initial adequate diabetes treatment aimed at reducing albuminuria may lead to improved renal prognosis in the primary care setting.
authors.affiliation: Corresponding author: Hiroki Yokoyama, dryokoyama@yokoyamanaika.com.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Araki
authors.forename: Jun
authors.initials: J
authors.lastname: Honjo
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okizaki
authors.forename: Daishiro
authors.initials: D
authors.lastname: Yamada
authors.forename: Ryushi
authors.initials: R
authors.lastname: Shudo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimizu
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Moriya
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000503:physiopathology*