High-normal ACR predicts renal damage in adolescents with diabetes
medwireNews: Having an albumin-to-creatinine ratio (ACR) at the upper end of the normal range predicts microalbuminuria and cardiovascular risk in adolescents with type 1 diabetes, say the AdDIT investigators.
Baseline data from the trial showed a cross-sectional association; this latest analysis shows that ACR also predicted nephropathy and cardiovascular risk over a median 3.9 years of follow-up.
“Over the next 3–4 years, AdDIT participants will be entering the second/third decade of type 1 diabetes and that critical postpubertal period when the first direct evidence of vascular complications is observed,” say David Dunger (University of Cambridge, UK) and study co-authors.
Further analysis of the cohort will show whether ACR remains predictive over the longer term, they add.
There were 150 study participants, aged 10–16 years, in the upper ACR tertile (average 1.23 mg/mmol), 10 of whom already had microalbuminuria. Excluding these people, 16.3% of the group developed microalbuminuria during follow-up, compared with just 5.5% of 396 patients in the lower two ACR tertiles (average 0.63 mg/mmol).
Having an ACR in the upper tertile remained predictive of microalbuminuria, at a hazard ratio of 4.29, after accounting for other baseline variables including glycated hemoglobin (HbA1c). HbA1c was the only other independent predictor, at a hazard ratio of 1.37 per percentage point increase.
ACR also predicted atherosclerotic cardiovascular risk, or at least increases in its surrogate endpoint carotid intima-media thickness (cIMT). At baseline, there was little difference between patients in the upper versus the two lower ACR tertiles, at 0.444 and 0.440 mm, respectively, but by the end of follow-up there was a significant difference, at 0.448 versus 0.434 mm.
This difference remained significant after accounting for age, sex, blood pressure, HbA1c, and low-density lipoprotein cholesterol.
Writing in Diabetes Care, the researchers caution that it remains to be seen to what extent ACR can improve prediction of nephropathy based on HbA1c and other established variables.
But they conclude that their findings “support the concept that risk stratification using ACR during early adolescence may be valuable for the early identification of patients at risk for developing renal and cardiovascular complications, and to guide the implementation of preventive and treatment strategies to reduce the burden associated with vascular complications of diabetes.”
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