Inflammation and progressive nephropathy in type 1 diabetes in the diabetes control and complications trial.

Abstract:

OBJECTIVE:Progressive nephropathy represents a substantial source of morbidity and mortality in type 1 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Early albuminuria probably reflects vascular endothelial dysfunction, which may be mediated in part by chronic inflammation. RESEARCH DESIGN AND METHODS:We measured baseline levels of four inflammatory biomarkers (high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1, and soluble tumor necrosis factor-alpha receptor-1) in stored blood samples from the 1,441 participants of the Diabetes Control and Complication Trial (DCCT). We used mixed-effects regression models to determine the average annual change in urinary albumin excretion rate (AER) by tertiles of each biomarker. We also used Cox proportional hazards models to estimate the relative risk of incident sustained microalbuminuria according to levels of each biomarker. RESULTS:After adjustment for baseline age, sex, duration of diabetes, A1C, and randomized treatment assignment, we observed a significantly higher 5.9 microg x min(-1) x year(-1) increase in AER among those in the highest compared with the lowest tertile of baseline sICAM-1 (P = 0.04). Those in the highest tertile of sICAM-1 had an adjusted relative risk of 1.67 (95% CI 0.96-2.92) of developing incident sustained microalbuminuria (P(trend) = 0.03). CONCLUSIONS:Higher baseline sICAM-1 levels predicted an increased risk of progressive nephropathy in type 1 diabetes and may represent an early risk marker that reflects the important role of vascular endothelial dysfunction in this long-term complication.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Lin J,Glynn RJ,Rifai N,Manson JE,Ridker PM,Nathan DM,Schaumberg DA

doi

10.2337/dc08-0277

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

2338-43

issue

12

eissn

0149-5992

issn

1935-5548

pii

dc08-0277

journal_volume

31

pub_type

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