Renal outcomes in patients with type 1 diabetes and macroalbuminuria

Ian H. De Boer, Maryam Afkarian, Tessa C. Rue, Patricia A. Cleary, John M. Lachin, Mark E. Molitch, Michael W Steffes, Wanjie Sun, Bernard Zinman

Research output: Contribution to journalArticle

37 Citations (Scopus)

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 incidentmacroalbuminuria during the Diabetes Control andComplications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. One hundred fifty-nine participants developed incident macroalbuminuria and were subsequently followed for amedian duration of 9 years (maximumof 25 years).At the timeofmacroalbuminuria 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 m2. 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 systeminhibitors. The cumulative incidence of impaired GFR (sustained eGFR<60 ml/ min per 1.73 m2) 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 kidneydisease.However, through at least 10 years of follow-up,AER could often be controlled, and GFR frequently remained in the normal range.

Original languageEnglish (US)
Pages (from-to)2342-2350
Number of pages9
JournalJournal of the American Society of Nephrology
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2014

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Type 1 Diabetes Mellitus
Albumins
Kidney
Incidence
Angiotensins
Diabetes Complications
Renin
Chronic Kidney Failure
Reference Values
Hemoglobins
Epidemiology
Urine
Therapeutics

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De Boer, I. H., Afkarian, M., Rue, T. C., Cleary, P. A., Lachin, J. M., Molitch, M. E., ... Zinman, B. (2014). Renal outcomes in patients with type 1 diabetes and macroalbuminuria. Journal of the American Society of Nephrology, 25(10), 2342-2350. https://doi.org/10.1681/ASN.2013091004

Renal outcomes in patients with type 1 diabetes and macroalbuminuria. / De Boer, Ian H.; Afkarian, Maryam; Rue, Tessa C.; Cleary, Patricia A.; Lachin, John M.; Molitch, Mark E.; Steffes, Michael W; Sun, Wanjie; Zinman, Bernard.

In: Journal of the American Society of Nephrology, Vol. 25, No. 10, 01.10.2014, p. 2342-2350.

Research output: Contribution to journalArticle

De Boer, IH, Afkarian, M, Rue, TC, Cleary, PA, Lachin, JM, Molitch, ME, Steffes, MW, Sun, W & Zinman, B 2014, 'Renal outcomes in patients with type 1 diabetes and macroalbuminuria', Journal of the American Society of Nephrology, vol. 25, no. 10, pp. 2342-2350. https://doi.org/10.1681/ASN.2013091004
De Boer IH, Afkarian M, Rue TC, Cleary PA, Lachin JM, Molitch ME et al. Renal outcomes in patients with type 1 diabetes and macroalbuminuria. Journal of the American Society of Nephrology. 2014 Oct 1;25(10):2342-2350. https://doi.org/10.1681/ASN.2013091004
De Boer, Ian H. ; Afkarian, Maryam ; Rue, Tessa C. ; Cleary, Patricia A. ; Lachin, John M. ; Molitch, Mark E. ; Steffes, Michael W ; Sun, Wanjie ; Zinman, Bernard. / Renal outcomes in patients with type 1 diabetes and macroalbuminuria. In: Journal of the American Society of Nephrology. 2014 ; Vol. 25, No. 10. pp. 2342-2350.
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