Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type
2 Diabetes
Shin-ichi Araki 1 ,
Masakazu Haneda 2 ,
Daisuke Koya 3 ,
Hideki Hidaka 4 ,
Toshiro Sugimoto 1 ,
Motohide Isono 1 ,
Keiji Isshiki 1 ,
Masami Chin-Kanasaki 1 ,
Takashi Uzu 1 and
Atsunori Kashiwagi 1
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
Abstract
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.
AER, albumin excretion rate
eGFR, estimated glomerular filtration rate
GFR, glomerular filtration rate
Footnotes
Published ahead of print at http://diabetes.diabetesjournals.org on 15 March 2007. DOI: 10.2337/db06-1646.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Accepted March 7, 2007.
Received November 24, 2006.
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Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

10.2337/db06-1646