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Arch Intern Med. 2011 Mar 14;171(5):412-20. doi: 10.1001/archinternmed.2011.16.

Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort.

Collaborators (342)

Genuth S, Nathan DM, Zinman B, Crofford O, Crandall J, Phillips M, Reid M, Brown-Friday J, Engel S, Sheindlin J, Martinez H, Shamoon H, Engel H, Dahms W, Palmert M, Gubitosi-Klug R, Mayer L, Pendegras S, Zegarra H, Miller D, Singerman L, Smith-Brewer S, Novak M, Gaston P, Genuth S, Brillon D, Lackaye ME, Reppucci V, Lee T, Heinemann M, Whitehouse F, McLellan M, Kruger D, Carey JD, Angus E, Croswell M, Galpirn A, Bergenstal R, Johnson M, Spencer M, Morgan K, Etzwiler D, Kendall D, Noller D, Jacobson A, Golden E, Beaser R, Ganda O, Hamdy O, Rosenzweig J, Wolpert H, Sharuk PG, Arrigg P, Burwood A, Rand L, Nathan DM, Larkin M, Godine J, Moore D, Cagliero E, Lou P, Fritz S, Service J, Ziegler G, Pach J, Colligan R, Lopes-Virella M, Colwell J, Hermayer K, Brabham M, Soule J, Blevins A, Parker J, Lee D, Lindsey P, Bracey M, Lee K, Nutaitis M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub-Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Schaefer B, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Shankle J, Astlesford P, Blackburn D, Ajroud-Driss S, Stone O, West C, Burnett-Zeigler I, Kolterman O, Lorenzi G, Goldbaum M, Harvey K, Ferreyra H, Sivitz W, Bayless M, Weingeist T, Stone E, Culver Boldt H, Gehres K, Russell S, Bayless J, Kramer J, Long J, Zeither R, Hebdon M, Donner T, Johnsonbaugh S, Gordon J, Hemady R, Kowarski A, Ostrowski D, Donner T, Steidl S, Jones B, Counts D, Herman W, Martin C, Pop-Busui R, Vine AK, Elner S, Feldman E, Albers J, Greene D, Stevens MJ, Bantle J, Rogness B, Olsen T, Steuer E, Rath P, Hainsworth D, Hitt S, Giangiacom J, Goldstein D, Schade D, Canady J, Schluter JM, Das A, Hornbeck D, Schwartz S, Bourne PA, Maschak-Carey BJ, Baker L, Braunstein S, Brucker A, Orchard T, Silvers N, Ryan C, Songer T, Doft B, Olson S, Bergren RL, Lobes L, Paczan Rath P, Becker D, Drash A, Morrison A, Vaccaro-Kish J, Bernal ML, Malone J, Pavan PR, Grove N, Iyer MN, Burrows AF, Tanaka EA, Gstalder R, Dagogo-Jack S, Wigley C, Ricks H, Kitabchi A, Murphy MB, Moser S, Meyer D, Iannacone A, Chaum E, Yoser S, Bryer-Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Ufret R, He YG, Edwards A, Alappatt J, Wilson C, Park S, Zinman B, Barnie A, MacLean S, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Palmer J, Catton S, Brunzell J, Ginsberg J, Kinyoun J, Van Ottingham L, Dupre J, Harth J, Nicolle D, Canny C, May M, Lipps J, Agarwal A, Adkins T, Survant L, Lorenz R, Feman S, White N, Levandoski L, Boniuk I, Grand G, Thomas M, Burgess D, Joseph D, Blinder K, Shah G, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Taylor K, Dahms W, Trail R, Quin J, Gaston P, Palmert M, Lachin J, Cleary P, Kenny D, Backlund J, Sun W, Rutledge B, Waberski B, Klumpp K, Chan K, Diminick L, Rosenberg D, Petty B, Determan A, Williams C, Dews L, Hawkins M, Cowie C, Fradkin J, Siebert C, Eastman R, Danis R, Davis M, Hubbard L, Geithman P, Kastorff L, Neider M, Badal D, Esser B, Miner K, Wabers H, Glander K, Joyce J, Robinson N, Hurtenbach C, Hannon C, Steffes M, Bucksa J, Chavers B, O'Leary D, Funk L, Polak J, Harrington A, Crow R, Gloeb B, Thomas S, O'Donnell C, Prineas R, Campbell C, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Low P, Sommer C, Nickander K, Detrano R, Wong N, Fox M, Kim L, Oudiz R, Weir G, Clark C, D'Agostino R, Espeland M, Klein B, Manolio T, Rand L, Singer D, Stern M, Lopes-Virella M, Garvey WT, Lyons TJ, Jenkins A, Klein R, Virella G, Jaffa AA, Lackland D, Brabham M, McGee D, Zheng D, Mayfield RK, Paterson A, Boright A, Bull S, Sun L, Scherer S, Zinman B, Brunzell J, Hokanson J, Marcovina S, Purnell J, Sibley S, Deeb S, Edwards K, Nathan DM.

Author information

1
Kidney Research Institute and Division of Nephrology, University of Washington, Campus Box 359606, 325 Ninth Ave, Seattle, WA 98104, USA. deboer@u.washington.edu

Abstract

BACKGROUND:

Microalbuminuria is a common diagnosis in the clinical care of patients with type 1 diabetes mellitus. Long-term outcomes after the development of microalbuminuria are variable.

METHODS:

We quantified the incidence of and risk factors for long-term renal outcomes after the development of microalbuminuria in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. The DCCT randomly assigned 1441 persons with type 1 diabetes to intensive or conventional diabetes therapy, and participants were subsequently followed up during the observational EDIC study. During the DCCT/EDIC study, 325 participants developed incident persistent microalbuminuria (albumin excretion rate, ≥30 mg/24 h at 2 consecutive study visits). We assessed their subsequent renal outcomes, including progression to macroalbuminuria (albumin excretion rate, ≥300 mg/24 h at 2 consecutive visits), impaired glomerular filtration rate (estimated glomerular filtration rate, <60 mL/min/1.73 m(2) at 2 consecutive study visits), end-stage renal disease, and regression to normoalbuminuria (albumin excretion rate, <30 mg/24 h at 2 consecutive visits).

RESULTS:

The median follow-up period after persistent microalbuminuria diagnosis was 13 years (maximum, 23 years). Ten-year cumulative incidences of progression to macroalbuminuria, impaired glomerular filtration rate, end-stage renal disease, and regression to normoalbuminuria were 28%, 15%, 4%, and 40%, respectively. Albuminuria outcomes were more favorable with intensive diabetes therapy, lower glycated hemoglobin level, absence of retinopathy, female sex, lower blood pressure, and lower concentrations of low-density lipoprotein cholesterol and triglycerides. Lower glycated hemoglobin level, absence of retinopathy, and lower blood pressure were also associated with decreased risk of impaired glomerular filtration rate.

CONCLUSIONS:

After the development of persistent microalbuminuria, progression and regression of kidney disease each commonly occur. Intensive glycemic control, lower blood pressure, and a more favorable lipid profile are associated with improved outcomes.

PMID:
21403038
PMCID:
PMC3085024
DOI:
10.1001/archinternmed.2011.16
[Indexed for MEDLINE]
Free PMC Article

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