What Predicts Progression and Regression of Urinary Albumin Excretion in the Nondiabetic Population?
Open Access
- 1 February 2007
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 18 (2), 637-645
- https://doi.org/10.1681/asn.2006070738
Abstract
An increase or decrease in urinary albumin excretion (UAE) is associated with, respectively, a higher or lower risk for renal and cardiovascular disease, independent of widely known cardiovascular risk factors. This study aimed to identify factors that are associated with changes in UAE in the nondiabetic population using data of the Prevention of Renal and Vascular End stage Disease (PREVEND) Study, a community-based prospective cohort study. Data of the 6647 nondiabetic participants who completed the first (1997 through 2001) and second (2001 through 2003) screening were used. Change in UAE was categorized as regression (n = 650), stable (n = 5240), or progression (n = 757) on the basis of change in class during follow-up, with classes being a UAE 300 mg/24 h. With the use of stepwise forward multinomial regression analysis changes in BP, fasting glucose concentration, and start of antihypertensive drugs were found to be the most important modifiable variables associated with the risk for progression and regression (P < 0.01 for likelihood ratio test). The odds ratios to develop regression or progression of UAE during follow-up were 0.64 (95% confidence interval [CI] 0.57 to 0.73) and 1.91 (95% CI 1.72 to 2.12), respectively, per 10-mmHg increase in BP during follow-up, 0.89 (95% CI 0.80 to 0.98) and 1.09 (95% CI 1.01 to 1.17), respectively, per 1-mmol/L increase of fasting glucose levels during follow-up, and 1.57 (95% CI 1.21 to 2.06) and 0.70 (95% CI 0.51 to 0.95), respectively, for start of antihypertensive drugs during follow-up. These associations were independent of baseline BP, glucose, body mass index, estimated GFR, and UAE and changes in high-sensitivity C-reactive protein during follow-up. In conclusion, changes in glucose concentration and BP and start of antihypertensive drugs (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in >50% of cases) are associated with progression and regression of UAE in the nondiabetic population. Although associations do not necessarily suggest causality, it is hypothesized that in the general population, the most important ways to reduce UAE are by lowering glucose concentration and BP (including start of antihypertensive medication), even in normotensive, nondiabetic individuals.Keywords
This publication has 38 references indexed in Scilit:
- Microalbuminuria as a Target to Improve Cardiovascular and Renal OutcomesAmerican Journal of Kidney Diseases, 2006
- Reduction in Albuminuria Translates to Reduction in Cardiovascular Events in Hypertensive PatientsHypertension, 2005
- From secondary to primary prevention of progressive renal disease: The case for screening for albuminuriaKidney International, 2004
- Inhibitors of HMG-CoA Reductase Reduce Receptor-mediated Endocytosis in Human Kidney Proximal Tubular CellsJournal of the American Society of Nephrology, 2004
- Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)Kidney International, 2003
- Rapid Progression of Albumin Excretion Is an Independent Predictor of Cardiovascular Mortality in Patients With Type 2 Diabetes and MicroalbuminuriaDiabetes Care, 2001
- Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)Jama-Journal Of The American Medical Association, 2001
- Microalbuminuria in essential hypertension: Significance, pathophysiology, and therapeutic implicationsAmerican Journal of Kidney Diseases, 1999
- Predictors of the development of microalbuminuria in patients with Type 1 diabetes mellitus: a seven‐year prospective studyDiabetic Medicine, 1999
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998