title: Renal outcomes in patients with type 1 diabetes and macroalbuminuria.
abstract: Macroalbuminuria, defined as urine albumin excretion rate (AER)≥300 mg/d, has long been considered a stage of irreversible kidney damage that leads reliably to GFR loss. We examined the long-term renal outcomes of persons with type 1 diabetes who developed incident macroalbuminuria during the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. One hundred fifty-nine participants developed incident macroalbuminuria and were subsequently followed for a median duration of 9 years (maximum of 25 years). At the time of macroalbuminuria diagnosis, mean (SD) age was 37 (9) years, mean (SD) duration of diabetes was 17 (5) years, median AER was 524 mg/d, and mean (SD) eGFR was 108 (20) ml/min per 1.73 m(2). Ten years after macroalbuminuria diagnosis, the cumulative incidence of a sustained reduction in AER to <300 mg/d was 52%, mostly but not entirely under treatment with renin-angiotensin system inhibitors. The cumulative incidence of impaired GFR (sustained eGFR<60 ml/min per 1.73 m(2)) 10 years after macroalbuminuria diagnosis was 32%, including 16% who developed ESRD. Lower hemoglobin A1c and BP and regression to AER<300 mg/d were associated with reduced risk of developing impaired GFR. In conclusion, people with type 1 diabetes who develop macroalbuminuria are at high risk of progressive kidney disease. However, through at least 10 years of follow-up, AER could often be controlled, and GFR frequently remained in the normal range.
authors.affiliation: Division of Nephrology and Kidney Research Institute and deboer@u.washington.edu.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Division of Nephrology and Kidney Research Institute and.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington;
authors.forename: Tessa C
authors.initials: TC
authors.lastname: Rue
authors.affiliation: Biostatistics Center, The George Washington University, Rockville, Maryland;
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: Biostatistics Center, The George Washington University, Rockville, Maryland;
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.affiliation: Division of Endocrinology, Northwestern University, Chicago, Illinois;
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
authors.affiliation: Biostatistics Center, The George Washington University, Rockville, Maryland;
authors.forename: Wanjie
authors.initials: W
authors.lastname: Sun
authors.affiliation: Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Zinman
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology* / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012307:Risk Factors