Renal Outcomes in Patients with Type 1 Diabetes and Macroalbuminuria

Abstract

Macroalbuminuria, defined as urine albumin excretion rate (AER)$300 mg/d, has long been considered a stage of irreversible kidney damage that leads reliably to GFR loss. We examined the long-term renal outcomes of persons with type 1 diabetes who developed incident macroalbuminuria during the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. One hundred fifty-nine participants developed incident macroalbuminuria and were subsequently followed for a median duration of 9 years (maximum of 25 years). At the time of macroalbuminuria diagnosis, mean (SD) age was 37 (9) years, mean (SD) duration of diabetes was 17 (5) years, median AER was 524 mg/d, and mean (SD) eGFR was 108 (20) ml/min per 1.73 m 2 . Ten years after macroalbuminuria diagnosis, the cumulative incidence of a sustained reduction in AER to ,300 mg/d was 52%, mostly but not entirely under treatment with renin-angiotensin system inhibitors. The cumulative incidence of impaired GFR (sustained eGFR,60 ml/ min per 1.73 m 2 ) 10 years after macroalbuminuria diagnosis was 32%, including 16% who developed ESRD. Lower hemoglobin A1c and BP and regression to AER,300 mg/d were associated with reduced risk of developing impaired GFR. In conclusion, people with type 1 diabetes who develop macroalbuminuria are at high risk of progressive kidney disease. However, through at least 10 years of follow-up, AER could often be controlled, and GFR frequently remained in the normal range.

Prevalence and Management of Diabetic Nephropathy in Western Countries

“…It also is associated with a high cumulative incidence of ESRD (75%) at 15 years of follow-up [14]. A recent study reporting on long-term renal outcomes in patients with type 1 diabetes who developed incident macroalbuminuria during the DCCT trial found that the cumulativeincidences of chronic kidney disease (CKD) and ESRD were only 32 and 16%, respectively, 10 years after diagnosis [15]. This supports the observation that reductions in AER are common, with more than half of type 1 diabetic patients with macroalbuminuria regressing to persistent AER <300 mg/day after long-term follow-up.…”

The effect of sodium glucose cotransporter 2 inhibition with empagliflozin on microalbuminuria and macroalbuminuria in patients with type 2 diabetes

“…Although not an ideal biomarker of renal risk, the presence of microalbuminuria has been linked to an increased risk for both cardiovascular events and progression of kidney disease in patients with type 2 diabetes. Macroalbuminuria is more consistently associated with an elevated risk of both renal and cardiovascular complications [2,3]. Therefore, regular assessment of albuminuria remains a clinical cornerstone to diagnose the onset of kidney disease in diabetes and to prospectively track the progression of renal injury.…”

Diabetische Nierenerkrankung – Update 2016

“…Bei optimaler Einstellung (HbA1c < 7) kam es nach 25 Jahren zu einer 36-bis 76-prozentigen Reduktion der mikrovaskulären Komplikationen im Vergleich zur Gruppe mit einem HbA1c~9 % [3]. Die Inzidenz der terminalen Niereninsuffizienz in der intensiv behandelten Gruppe lag bei 11/1000 Patienten [4]. Sobald entweder eine Hypertonie oder eine Albuminurie (ab Stadium A2) vorliegt, gilt die medikamentöse RAAS-Blockade als Therapiegesichert [5,6].…”