OBJECTIVE -The value of microalbuminuria (MA) in predicting renal disease and premature mortality in longer duration type 1 diabetes is unclear.RESEARCH DESIGN AND METHODS -We followed 135 patients with longstanding type 1 diabetes (Ͼ30 years' duration) over a 7-year period, recording albuminuria and other clinical variables. Vital status was ascertained and cause of death was recorded.RESULTS -A total of 27 of 135 patients (20%) died during the follow-up period. Patients with MA (10 of 30, 33.3%) or proteinuria (5 of 6, 83.3%) at initial examination were more likely to die during follow-up than patients who had normal albumin excretion at baseline (12 of 99, 12%; 2 for trend 21.9, P Ͻ 0.0001). The presence of abnormal albumin excretion and low BMI were independent risk factors of premature death. The causes of death were similar in patients with normal and abnormal urine albumin excretion. A total of 24.4% of initially normoalbuminuric survivors developed MA, and persistent proteinuria developed in 3.5%. Progressors had significantly higher albumin excretion rate at baseline compared with those who remained normoalbuminuric: 9.0 g/min (3.8 -18) vs. 4.0 g/min (0.4 -17.5); P Ͻ 0.001. A total of 21% of patients with MA at baseline reverted to normoalbuminuria, and persistent proteinuria developed in 32%. The likelihood of progression to persistent proteinuria was significantly greater in those with baseline MA compared with those with normal albumin excretion (P Ͻ 0.001).CONCLUSIONS -Even in long-standing type 1 diabetes of Ͼ30 years' duration, MA and proteinuria predict all-cause mortality. MA is a good predictor of persistent proteinuria. Diabetes Care 26:2144 -2149, 2003T he cumulative incidence of diabetic nephropathy, defined as persistent proteinuria, is ϳ40% after 40 years of type 1 diabetes (1). The incidence increases sharply 10 years after onset of diabetes but is low after 35 years; only 4% develop persistent proteinuria thereafter.In patients with type 1 diabetes, microalbuminuria (MA) precedes persistent proteinuria and is an accepted early phase of nephropathy (2-4). It is also a risk marker for premature death in these patients, generally from cardiovascular disease (5-8). However, the predictive value of MA in longer-duration type 1 diabetes has been questioned (9). In a 10-year follow-up of 18 MA patients with duration of type 1 diabetes Ն15 years, only 5 patients developed proteinuria and none developed end-stage renal failure. However, in cross-sectional studies, the prevalence of MA in patients with duration of diabetes Ͼ30 years is 23-50% (10,14). In one study, these patients with long-duration MA had lower glomerular filtration rates and higher serum creatinine levels than normoalbuminuric patients of similar duration (10). This suggests that even with long-duration diabetes, patients with MA may be at high risk for progression to endstage renal failure. There is also insufficient information on the role of MA in predicting premature mortality in patients with MA and long-standing diabetes.Ou...

The following results were obtained from a series of investigations in which alveolar hyperventilation was controlled within narrow limits. (1) Delta rhythm was not directly related to alveolar ventilation, alveolar carbon dioxide tension or excretion of carbon dioxide. The appearance of d:lta rhythm was not necessarily associated with loss of consciousness. (2) Frontal alpha rhythm was apparently related to alveolar ventilation volume, although insufficient evidence was available for statistical proof. (3) It was considered that the cerebral effects of hyperventilation were due to hypoxia, and subjects were found to vary considerably in sensitivity to such effects.