NDT Advance Access originally published online on August 24, 2004
Nephrology Dialysis Transplantation 2004 19(11):2784-2788; doi:10.1093/ndt/gfh470
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Nephrol Dial Transplant Vol. 19 No. 11 © ERA-EDTA 2004; all rights reserved
Original Article
Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria
1 Steno Diabetes Center and 2 Faculty of Health Science, University of Aarhus, Denmark
Correspondence and offprint requests to: Peter Gæde, Steno Diabetes Center, Gentofte, Denmark. Email: p.gaede{at}dadlnet.dk
Background. Intervention studies in microalbuminuric type 2 diabetic patients have demonstrated that it is possible to avoid progression to overt diabetic nephropathy and even to achieve regression to normoalbuminuria. However, the long-term impact of stabilization/regression in albuminuria on decline in glomerular filtration rate (GFR) has not been established.
Methods. 151 patients with type 2 diabetes and microalbuminuria at baseline in whom GFR was measured at least three times during 7.8 years of follow-up were divided into three groups according to the level of albuminuria during follow-up. Overt nephropathy was diagnosed as a urinary albumin excretion rate (AER) >300 mg/24 h and remission to normoalbuminuria was defined as an AER <30 mg/24 h at the last examination.
Results. During follow-up, 46 patients achieved remission to normoalbuminuria, 58 remained microalbuminuric and 47 patients progressed to overt nephropathy. The mean (± SE) yearly decline in GFR was lowest (2.3±0.4 ml/min/year) in patients who obtained remission, in comparison with patients remaining microalbuminuric, in whom the decline was 3.7±0.4 ml/min/year, and patients progressing to overt nephropathy, who had a decline in GFR of 5.4±0.5 ml/min/year (ANOVA, P<0.001). Start of antihypertensive treatment during follow-up was strongly associated with remission to normoalbuminuria [odds ratio: 2.32; 95% confidence interval (CI): 1.09–4.93] whereas a decrease in HbA1c by 1% increased the probability for remission (odds ratio: 1.48; 95% CI: 1.11–1.97).
Conclusions. Remission to normoalbuminuria was associated with a decreased GFR decline during 7.8 years of follow-up in type 2 diabetic patients with microalbuminuria. Antihypertensive therapy and improved glycaemic control were independent predictors for remission.
Keywords: glomerular filtration rate; kidney function; remission; risk reduction; type 2 diabetes mellitus; urinary albumin excretion rate
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