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

Abstract

Abstract. Aim: The aim of this study was to clarify the rates of remission and progression for microalbuminuria in patients with type 2 diabetes (T2DM); and factors associated with remission and progression of diabetic nephropathy (DN). Patients and Methods: T2DM patients with a urinary albumin excretion (UAE) rate of 30-300 mg/gCr who were attending the medical clinic in the Tsugaru region in Japan were enrolled into this prospective, observational study for 36 months (N=317). We investigated the rate of remission (UAE <30 mg/g creatinine (Cr); normal albuminuria) and the rate of progression (UAE ≥300 mg/gCr; overt proteinuria) 36 months after study registration. Results: The number of patients whose UAE levels were <30 mg/gCr (DN remission) at 36 months after registration was 64 (27.4%), and the number of patients whose UAE levels were ≥300 mg/gCr (DN progression) at 36 months after registration was 32 (13.7%). From multiple logistic regression analysis, the sole factor that contributed to remission at 36 months after registration was the UAE levels at registration (OR: 0.99; p=0.003) Diabetic nephropathy (DN) is the leading cause of end-stage renal failure in patients with type 2 diabetes mellitus, and its prevalence is increasing annually worldwide. Compared to 20 years ago, the incidence of diabetic complications without DN has decreased; however, DN is still the main complication in diabetes (1). On the other hand, high incidences of DN in type 2 diabetic patients have been reported, at 40-60% (2, 3). Further DN is a strong risk factor for atherosclerosis and cardiovascular disease compared to chronic kidney disease without diabetes (4). Additionally, at present, patients with end-stage DN in Japan comprise over 40% of the patients starting dialysis therapy in one year (5).Therefore, if we could prevent DN progression, we could be able to consequently prevent the need for dialysis in these patients. Unfortunately, an effective treatment strategy has not yet been developed for DN. According to recent studies, the early detection and treatment of DN, including measuring urinary albumin excretion (UAE), the strict control of blood sugar, blood pressure and treatment for other risks (multifactorial intervention), are considered very important (6-9). However, it is unclear whether such procedure/treatment is actually routinely performed. 285This article is freely accessible online. Thus, the aim of the present study was to clarify whether multifactorial intervention was actually performed. Because we were investigating the change of albuminuria in patients with DN, we assessed the remission and progression rates of microalbuminuria using a 36-month follow-up survey. Patients and MethodsStudy design and procedure. Type 2 diabetes patients with a UAE of 30-300 mg/g creatinine (Cr) who were attending the medical clinic in the Tsugaru region of Aomori district Japan were enrolled in this study after giving their written informed consent. Each medical clinic sent the study registration data [verification of age, ...

Diabetic nephropathy ameliorated in patients with normal home blood pressure compared to those with isolated high home systolic blood pressure: A 5-year prospective cohort study among patients with type 2 diabetes mellitus

“…Participants using ARB/ACE-I are at a lower risk of diabetic nephropathy and more frequently experience remission or regression of diabetic nephropathy. [10][11][12][13][14][15] However, remission or regression of diabetic nephropathy was shown less frequently in patients using ARB/ACE-I than in patients not using ARB/ACE-I (17.5% vs. 31.2%) in our study. It should be attention to patients in this group had higher SBP (142.6 vs 135.3 mmHg, p < 0.01) than patients without ARB/ACE-I.…”

“…A mechanism likely to account for the association between good SBP control and remission or regression of diabetic nephropathy has been described elsewhere. [10][11][12][13][14][15] Inadequately controlled SBP at baseline may induce hemodynamic changes in patients with type 2. 14 The pathogenesis of ISH is enrolled increased arterial stiffness.…”

“…8,9 In contrast, rigorous control of SBP is associated with remission or regression of diabetic nephropathy. [10][11][12][13] The optimal home SBP for remission induction or regression of microalbuminuria might be below 130 mmHg. 14 Using an angiotensin II receptor blocker (ARB) reduced microalbuminuria in Japanese with patients type 2 diabetes mellitus (DM) regardless of with or without hypertension.…”