Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study
Open Access
- 19 April 2004
- Vol. 328 (7448), 1105
- https://doi.org/10.1136/bmj.38070.450891.fe
Abstract
ObjectiveTo evaluate baseline predictors for the development of persistent microalbuminuria and macroalbuminuria prospectively in patients with type 1 diabetes. DesignProspective observational study of an inception cohort. SettingOutpatient diabetic clinic in a tertiary referral centre, Gentofte, Denmark. Participants286 patients (216 adults) newly diagnosed with type 1 diabetes consecutively admitted to the clinic between 1 September 1979 and 31 August 1984. Main outcome measuresPersistent microalbuminuria and persistent macroalbuminuria. ResultsDuring the median follow up of 18.0 years (range 1.0-21.5 years), total of 4706 patient years of follow up, 79 of 277 (29%) patients developed persistent microalbuminuria. 27 of 79 progressed further to persistent macroalbuminuria. The cumulative incidence of persistent microalbuminuria and persistent macroalbuminuria was 33.6% (95% confidence interval 27.2% to 40.0%) and 14.6% (8.9% to 20.3%), respectively. Significant predictors for the development of persistent microalbuminuria were a 10-fold increase in urinary albumin excretion rate (relative risk 3.78, 1.57 to 9.13), being male (2.41, 1.43 to 4.06), a 10 mm Hg increase in mean arterial blood pressure (1.38, 1.20 to 1.57), a 1% increase in haemoglobin A1c(1.18, 1.04 to 1.32), and a 1 cm increase in height (0.96, 0.95 to 0.98). 28 patients with microalbuminuria (35%) regressed to normoalbuminuria either transiently (n = 15) or permanently (n = 13). ConclusionsAround one third of patients newly diagnosed with type 1 diabetes develop persistent microalbuminuria within the first 20 years of diabetes. Several potentially modifiable risk factors predict the development of persistent microalbuminaria and persistent macroalbuminuria.Keywords
This publication has 30 references indexed in Scilit:
- Regression of Microalbuminuria in Type 1 DiabetesNew England Journal of Medicine, 2003
- Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 DiabetesNew England Journal of Medicine, 2002
- Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven‐year prospective studyDiabetic Medicine, 1999
- Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications TrialKidney International, 1995
- Predictors of Microalbuminuria in Individuals with IDDM: Pittsburgh Epidemiology of Diabetes Complications StudyDiabetes Care, 1993
- Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes*1The Lancet, 1993
- Blood pressure, stroke, and coronary heart disease *1Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution biasThe Lancet, 1990
- Raised arterial pressure in parents of proteinuric insulin dependent diabetics.BMJ, 1987
- MICROALBUMINURIA AS A PREDICTOR OF CLINICAL NEPHROPATHY IN INSULIN-DEPENDENT DIABETES MELLITUSThe Lancet, 1982
- B-cell function and blood glucose control in insulin dependent diabetics within the first month of insulin treatmentDiabetologia, 1977