Fanny J Jansson1,2,3, Carol Forsblom1,2,3, Valma Harjutsalo1,2,3,4, Lena M Thorn1,2,3, Johan Wadén1,2,3, Nina Elonen1,2,3, Aila J Ahola1,2,3, Markku Saraheimo1,2,3, Per-Henrik Groop5,6,7,8. 1. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, FIN - 00290, Helsinki, Finland. 2. Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. 3. Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. 4. The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. 5. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, FIN - 00290, Helsinki, Finland. per-henrik.groop@helsinki.fi. 6. Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. per-henrik.groop@helsinki.fi. 7. Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi. 8. Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia. per-henrik.groop@helsinki.fi.
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.
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.
Entities:
Keywords:
Albumin excretion rate; Albuminuria; Cardiovascular disease; Diabetic nephropathy; Mortality; Type 1 diabetes
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