Regression of albuminuria and its association with incident cardiovascular outcomes and mortality in type 1 diabetes: the FinnDiane Study.

Abstract:

AIMS/HYPOTHESIS:Our aim was to assess regression of albuminuria and its clinical consequences in type 1 diabetes. METHODS:The analysis included 3642 participants from the Finnish Diabetic Nephropathy (FinnDiane) Study with a 24 h urine sample and a history of albuminuria available at baseline. A total of 2729 individuals had normal AER, 438 a history of microalbuminuria and 475 a history of macroalbuminuria. Regression was defined as a change from a higher category of albuminuria pre-baseline to a lower category in two out of the three most recent urine samples at baseline. The impact of regression on cardiovascular events (myocardial infarction, stroke, coronary procedure) and mortality was analysed over a follow-up of 14.0 years (interquartile range 11.9-15.9). RESULTS:In total, 102 (23.3%) individuals with prior microalbuminuria and 111 (23.4%) with prior macroalbuminuria had regressed at baseline. For individuals with normal AER as a reference, the age-adjusted HRs (95% CI) for cardiovascular events were 1.42 (0.75, 2.68) in individuals with regression from microalbuminuria, 2.62 (1.95, 3.54) in individuals with sustained microalbuminuria, 3.15 (2.02, 4.92) in individuals with regression from macroalbuminuria and 5.49 (4.31, 7.00) in individuals with sustained macroalbuminuria. Furthermore, for all-cause and cardiovascular mortality rates, HRs in regressed individuals were comparable with those with sustained renal status at the achieved level (i.e. those who did not regress but remained at the most advanced level of albuminuria noted pre-baseline). CONCLUSIONS/INTERPRETATION:Progression of diabetic nephropathy confers an increased risk for cardiovascular disease and premature death. Notably, regression reduces the risk to the same level as for those who did not progress.

journal_name

Diabetologia

journal_title

Diabetologia

authors

Jansson FJ,Forsblom C,Harjutsalo V,Thorn LM,Wadén J,Elonen N,Ahola AJ,Saraheimo M,Groop PH,FinnDiane Study Group.

doi

10.1007/s00125-018-4564-8

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

1203-1211

issue

5

eissn

0012-186X

issn

1432-0428

pii

10.1007/s00125-018-4564-8

journal_volume

61

pub_type

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