title: Levels of albuminuria and risk of developing macroalbuminuria in type 2 diabetes: historical cohort study.
abstract: Although increased urinary albumin excretion may increase the risk of adverse renal outcomes in patients with diabetes, it remains unclear whether microalbuminuria is associated with a higher incidence of macroalbuminuria in the absence of non-diabetic kidney events that frequently develop during the long-term course of type 2 diabetes. This historical cohort study included patients with type 2 diabetes, spot urine albumin:creatinine ratio (ACR) <300 mg/gCr and normal serum creatinine concentrations treated between August 1988 and April 2015. Patients with any evidence suggesting non-diabetic kidney diseases at baseline were excluded. Over a median follow-up of 50 months, 70 of the 1760 included patients developed macroalbuminuria. Twenty-one of these patients were diagnosed with non-diabetic renal events. The five-year cumulative incidence of macroalbuminuria in patients with ACRs of 0-7.5 mg/gCr, 7.5-30 mg/gCr, 30-150 mg/gCr, and 150-300 mg/gCr were 0%, 0.53%, 3.5%, and 36.0%, respectively, with significant differences between each pair of ACR categories. In type 2 diabetes, higher urinary ACR, even within a level of normoalbuminuria, was associated with a greater incidence of macroalbuminuria when non-diabetic renal events were excluded. These results conflict with findings suggesting that microalbuminuria is a poor indicator for the progression of diabetic nephropathy.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Shoma
authors.initials: S
authors.lastname: Chida
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Raishi
authors.initials: R
authors.lastname: Ichikawa
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kamata
authors.affiliation: Department of Medical Informatics, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takeuchi
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takano
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Shichiri
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000652:urine; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D000075462:Serum Albumin, Human / Q000652:urine*
chemical_list: D003404:Creatinine; D000075462:Serum Albumin, Human