Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion

Parving, Hans‐Henrik; Oxenbøll, B; Svendsen, P.; Christiansen, John; Andersen, Andreas

doi:10.1530/acta.0.1000550

Cited by 532 publications

(250 citation statements)

References 6 publications

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“…In older studies microalbuminuria was considered a very strong predictor of diabetic nephropathy [25,26,27]. The prevalence of microalbuminuria was much higher in these studies than in our study (17-36% compared with 6-12%), even though their definitions were often stricter with microalbuminuria in repeated urine samples.…”

Section: Discussioncontrasting

confidence: 71%

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Nordwall

Bojestig²,

Arnqvist³

et al. 2004

Diabetologia

187

122

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Aims/hypothesis. In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to10 years later in the same population. Methods. We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninetyone percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes.Results. The cumulative proportion of severe retinopathy had declined (p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years, it was 32% (20-44) and 11% (2-20) for the oldest cohorts (p<0.0001). Conclusions/interpretation. In an unselected population with Type 1 diabetes diagnosed in childhood, modern diabetes care markedly reduced the incidence of severe retinopathy and nephropathy.

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Section: Discussioncontrasting

confidence: 71%

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Nordwall

Bojestig²,

Arnqvist³

et al. 2004

Diabetologia

187

122

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“…Early retrospective studies described a risk of progression from microalbuminuria to macroalbuminuria of approximately 80% in 6 to 14 years (i.e. six to ten per 100 person-years) [14,15,16]. However, in subsequent observational and intervention studies, the observed rate of progression was shown to vary considerably between 2.8 [17] and 13 [18] per 100 person-years.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

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“…Furthermore, a progression rate from micro-to macroalbuminuria of roughly 80% was originally reported during an observation period of 10-14 years in type 1 diabetic patients not receiving RAAS-blocking treatment [1][2][3]. Subsequently, multiple trials have looked at progression rates from micro-to macroalbuminuria and reported progression rates ranging from 5.6 to 30%/year [5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have previously been reported [1][2][3][4][5][6][7][8][9][10]. Several clinical trials of short or medium duration have shown a beneficial effect of blocking the renin-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) on progression of albuminuria, the development of diabetic nephropathy and the decline in kidney function [6,7,[9][10][11][12][13][14][15].…”

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confidence: 99%

Long-term prevention of diabetic nephropathy: an audit

et al. 2008

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Aims/hypothesis In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in microalbuminuric type 1 diabetic patients on progression of microalbuminuria and development of DN. Methods All patients with type 1 diabetes and persistent microalbuminuria (30-300 mg/24 h) were identified (n=227) in 1995 at Steno Diabetes Center and followed for 11 years. Development of DN was defined as a UAER of >300 mg/24 h in two of three consecutive urine samples. Results Age and duration of diabetes at baseline (mean±SD) were 46±15 and 28±13 years, respectively. During followup 14 patients emigrated and 58 (26%) died. Over the same period 79% were treated with an ACEI or ARB. There was a mean decline in UAER of 4%/year. Sixty-five patients (29%) progressed to overt DN, corresponding to 3.1%/year. However, 29 of them regressed to normo-or microalbuminuria on intensified antihypertensive treatment. Glycaemic control and blood pressure remained nearly unchanged. Conclusions/interpretation In our outpatient clinic, the implementation of RAAS-blocking treatment in type 1 diabetic patients with microalbuminuria successfully reduced longterm progression to overt DN to a rate similar to those previously reported in randomised, double-blind intervention trials of shorter duration using RAAS blockade.

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Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion

Cited by 532 publications

References 6 publications

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes—the Linköping Diabetes Complications Study

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Long-term prevention of diabetic nephropathy: an audit

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