NDT Advance Access published online on August 24, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh470
© 2004 by European Renal Association - European Dialysis and Transplant Association
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1 Steno Diabetes Center, University of Aarhus, Denmark
* To whom correspondence should be addressed. E-mail: 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.
Accepted July 21, 2004
Original Papers
Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria
2 Steno Diabetes Center, University of Aarhus, Denmark; Faculty of Health Science, University of Aarhus, Denmark
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