title: Systolic blood pressure as a predictor of incident albuminuria and rapid renal function decline in type 2 diabetic patients.
abstract: OBJECTIVE
  Albuminuria and a reduced estimated glomerular filtration rate (eGFR) are known risk factors of poor cardiovascular outcomes in diabetic patients. We here aimed to investigate the determinants of incident albuminuria and rapid progression of renal dysfunction in patients with type 2 diabetes.
  
  
  METHODS
  Type 2 diabetic outpatients (n=215) with a mean baseline eGFR of 87±20 mLmin(-1)1.73 m(-2) were followed for 12 months. Urinary albuminuria was defined according to the urine albumin-to-creatinine ratio (UACR).
  
  
  RESULTS
  Among 132 patients with normoalbuminuria at baseline, 20 (15.2%) progressed to a more advanced stage of albuminuria within 1 year, and 20.5% of the 215 patients experienced a rapid decline in eGFR (eGFR reduction >5 mLmin(-1)1.73 m(-2)year(-1)). After adjusting for potential confounders, both baseline UACR and systolic blood pressure (SBP) were found to be significant independent factors for incident albuminuria and a rapid decline of eGFR in separate models. Using receiver operating characteristic curves, systolic blood pressures of 132 and 138 mmHg were found to predict incident albuminuria and a rapid decline of eGFR, respectively.
  
  
  CONCLUSIONS
  In addition to baseline UACR, SBP is one of the most powerful modifiable independent risk factors for incident albuminuria and a rapid renal function decline in type 2 diabetic patients without symptomatic cardiovascular disease.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, Sanmin Road, Taichung 402, Taiwan.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Sheen
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, Sanmin Road, Taichung 402, Taiwan.
authors.forename: Jiann-Liang
authors.initials: JL
authors.lastname: Lin
authors.affiliation: Institute of Biostatistics, China Medical University, No. 91 Hsueh-Shih Road, Taichung 404, Taiwan.
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, Sanmin Road, Taichung 402, Taiwan.
authors.forename: Cho-Tsan
authors.initials: CT
authors.lastname: Bau
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Medical Technology, National Chung-Hsing University, Taichung, Taiwan. Electronic address: whhsheu@vghtc.gov.tw.
authors.forename: Wayne H-H
authors.initials: WH
authors.lastname: Sheu
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: Estimated glomerular filtration rate; Rapid decline; Systolic blood pressure; Type 2 diabetes; Urine albumin-to-creatinine ratio