Development, Progression, and Regression of Microalbuminuria in Japanese Patients With Type 2 Diabetes Under Tight Glycemic and Blood Pressure Control

Abstract

TORU AIZAWA, MD 4OBJECTIVE -The goal of this study was to know the fate of albuminuria in Japanese patients with type 2 diabetes under tight blood pressure and glycemic control.RESEARCH DESIGN AND METHODS -Patients having normoalbuminuria (urinary albumin excretion Ͻ30 mg/g creatinine, n ϭ 179) or microalbuminuria (albumin excretion 30 -299 mg/g creatinine, n ϭ 94) at baseline have been followed up for 8 years: ratio of men to women was 160/113, the mean age was 58 years, pretreatment HbA 1c (A1C) was 8.8%, and blood pressure was 136/76 mmHg. A1C Ͻ6.5% and blood pressure Ͻ130/80 mmHg were targeted, and the A1C of 6.5 Ϯ 0.7% (mean Ϯ SD) and blood pressure of 127 Ϯ 11/72 Ϯ 6 mmHg have been maintained during the 8 years. Development of microalbuminuria or macroalbuminuria (albumin excretion Ն300 mg/g creatinine) in initially normoalbuminuric patients and progression to macroalbuminuria or regression to normoalbuminuria in initially microalbuminuric patients were assessed at year 8.RESULTS -Development occurred in 27 (15%) of the normoalbuminuric patients and progression and regression in 16 (17%) and 20 (21%), respectively, of the microalbuminuric patients. Significant independent relationships existed between development and higher achieved mean systolic blood pressure (SBP) and regression and lower achieved mean SBP. In the patients with achieved mean SBP Ͻ120 mmHg, development was 3%, progression was 11%, and regression was 44% during 8 years. Prediction for nephropathy by blood pressure and glycemia alone was limited. Nevertheless, albumin excretion at year 8 was positively correlated with achieved mean SBP and baseline albuminuria.CONCLUSIONS -Development and progression were low and regression was high with SBP of 120 mmHg, provided A1C was maintained at 6.5%. Diabetes Care 28:2733-2738, 2005D iabetic nephropathy is now the leading cause of end-stage renal failure in Europe, the U.S., and Japan (1), and the establishment of an effective treatment strategy for diabetic nephropathy is of paramount importance. In particular, early intervention is hoped to bring about 1) the prevention of new development of nephropathy, 2) the prevention of progression of early-phase nephropathy, and 3) the regression of existing nephropathy (1-3). Urinary albumin excretion (UAE) is a marker of earlyphase diabetic nephropathy (1-3), and the amount of UAE correlates with renal pathologic changes in both type 1 and type 2 diabetes (4). Accordingly, many studies have been performed with UAE as a marker of diabetic nephropathy (5-7). The development and progression of nephropathy were improved by glycemic and blood pressure controls as expected (5-8). Antihypertensive therapy and improved glycemic control were independent predictors of the regression from micro-to normoalbuminuria (8). In this study, we analyzed the fate of early-phase diabetic nephropathy as indexed by the change in UAE in Japanese patients with type 2 diabetes over an 8-year period. In particular, the relationship between blood pressure and the state of albuminuria...

Factors Associated with Microalbuminuria Remission in Patients with Type 2 Diabetes: Importance of Early Intervention for Microalbuminuric Patients (TSUGARU STUDY)

“…These results suggest that strict control of BS might contribute to microalbuminuria remission 36 months after registration. These results were similar to those of precious reports (8,14,16).…”

“…These results suggest that strict control of BS might contribute to microalbuminuria remission 36 months after registration. These results were similar to those of precious reports (8,14,16).As shown in Table V, the sole factor that contributed to remission at 36 months after registration was the levels of UAE at registration. The results suggest that the strict control of the UAE levels is very important.…”

“…The increased use of these drugs could be attributed to the additional comments about the current standard management of DN at registration from the study office. Although this study was not an interventional study, these results suggest that the clinicians in the region gradually gained more knowledge on the diagnosis and management of DN throughout the duration of this study.Compared to the results from several studies which that showed the rate of microalbuminuria remission in DN (8,[11][12][13][14][15][16], the rate found in the present study, 27.4%, was not very high. Most of the contributors in this study were general physicians, not diabetes specialists, many previous papers on DN were reported from diabetic specialist faculties, such as, university hospitals or diabetic centers (8,(11)(12)(13)(14)(15)(16).…”

“…Most of the contributors in this study were general physicians, not diabetes specialists, many previous papers on DN were reported from diabetic specialist faculties, such as, university hospitals or diabetic centers (8,(11)(12)(13)(14)(15)(16). Consequently, our results in this study might accurately reflect the situation of actual clinical practice.…”

Intervention at the very early stage of type 2 diabetes

“…In Japan, and maybe some other countries, this is a realistic expectation: the national health system for the general population is well organised, with approximately 65% of adults having their plasma glucose and HbA 1c measurements assessed annually. Accordingly, patients with type 2 diabetes are often seen by healthcare professionals at the very early stage [2,3].…”