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Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

¹ Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
² Second Department of Medicine, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
³ Division of Endocrinology and Metabolism, Department of Medicine, Kanazawa Medical School, Kahoku-gun, Ishikawa, Japan
⁴ Medical and Health Care Center, SANYO Electric Group Health Insurance Association, Moriguchi, Osaka, Japan

Address correspondence and reprint requests to Shin-ichi Araki, MD, PhD, Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan. E-mail: araki{at}belle.shiga-med.ac.jp

Abbreviations: AER, albumin excretion rate; eGFR, estimated glomerular filtration rate; GFR, glomerular filtration rate

OBJECTIVE—Microalbuminuria in diabetic patients is a predictor for diabetic nephropathy and cardiovascular disease. The aim of this study is to investigate the clinical impact of reducing microalbuminuria in type 2 diabetic patients in an observational follow-up study.

RESEARCH DESIGN AND METHODS—We enrolled 216 type 2 diabetic patients with microalbuminuria during an initial 2-year evaluation period and observed them for the next 8 years. Remission and a 50% reduction of microalbuminuria were defined as a shift to normoalbuminuria and a reduction <50% from the initial level of microalbuminuria. The association between reducing microalbuminuria and first occurrence of a renal or cardiovascular event and annual decline rate of estimated glomerular filtration rate (eGFR) was evaluated.

RESULTS—Twelve events occurred in 93 patients who attained a 50% reduction of microalbuminuria during the follow-up versus 35 events in 123 patients without a 50% reduction. The cumulative incidence rate of events was significantly lower in patients with a 50% reduction. A pooled logistic regression analysis revealed that the adjusted risk for events in subjects after a 50% reduction was 0.41 (95% CI 0.15–0.96). In addition, the annual decline rate of eGFR in patients with a 50% reduction was significantly slower than in those without such a reduction. The same results were also found in the analysis regarding whether remission occurred.

CONCLUSIONS—The present study provides clinical evidence implying that a reduction of microalbuminuria in type 2 diabetic patients is an integrated indicator for renal and cardiovascular risk reduction.

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