medwireNews: Improvement in albuminuria is associated with a reduction in the risk for cardiovascular disease (CVD) and mortality among patients with diabetic nephropathy, results of the FinnDiane study suggest.
“Progression of albuminuria status is not always inevitable, and regression to less advanced stages can occur,” say Per-Henrik Groop (University of Helsinki, Finland) and study co-authors.
The researchers analyzed albumin excretion rates (AERs) in urine samples from 3642 patients with type 1 diabetes, 12.0% of whom were classified as having microalbuminuria (AER=30–300 mg/24 h) and 13.0% of whom were macroalbuminuric (AER>300 mg/24 h) prior to the first FinnDiane study visit.
In all, 23.3% of the 438 patients with initial microalbuminuria and 23.4% of the 475 with macroalbuminuria experienced regression, defined as a change from a higher to a lower category of albuminuria in two out of three of the most recent urine samples, at study baseline.
When participants were categorized into groups based on albuminuria with or without regression, 18.4% of those with persistent microalbuminuria experienced myocardial infarction, stroke, or a coronary procedure over a median 14 years of follow-up. This translated into a significant 2.62-fold increased risk compared with patients who had a normal AER throughout the study, 6.3% of whom experienced cardiovascular events.
However, only 10.4% of patients with microalbuminuria regression experienced cardiovascular events, and this rate was not significantly different from that in the group of patients with persistent normal AER.
Rates of cardiovascular events were 33.7% for those with persistent macroalbuminuria, which was significantly higher than the 23.2% rate for those who experienced a reduction in AER following macroalbuminuria. Patients with macroalbuminuria regression were significantly more likely to experience cardiovascular events than those with a consistently normal AER, however.
Those who experienced regression of micro- or macroalbuminuria also had a significantly lower risk for mortality than their counterparts who had no improvement in their renal status, report Groop and team in Diabetologia.
Together, these findings suggest that patients who experience regression of albuminuria have a similar risk for CVD and mortality as those who do not experience progression in the first place, say the researchers.
And they conclude: “The present study underlines the importance of keeping the AER as close to the normal levels as possible in order to improve outcomes in type 1 diabetes.”
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