The Development and Progression of Renal Insufficiency with and without Albuminuria in Adults with Type 1 Diabetes Mellitus in the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) Study

  1. for the Epidemiology of Diabetes Interventions and Complications Study Group
  1. 1. Northwestern University, Chicago, IL
  2. 2. University of Minnesota, Minneapolis, MN
  3. 3. The George Washington University, The Biostatistics Center, Rockville, MD
  4. 4. Weststat, Rockville, MD
  5. 5. University of Washington, Seattle, WA
  6. 6. University of Toronto, Toronto, Ontario

Abstract

Objective: This multicenter study examined the impact of albumin excretion rate (AER) on the course of estimated glomerular filtration rate (eGFR) and the incidence of sustained eGFR <60 ml/min/1.73m2 in type 1 diabetes up to Year 14 of EDIC (mean duration of 19 years in DCCT/EDIC).

Research design and methods: Urinary albumin measurements from 4-hour urine collections were obtained from participants annually during the DCCT and every other year during EDIC and serum creatinine was measured annually in both the DCCT and EDIC. GFR was estimated (eGFR) from serum creatinine using the abbreviated Modification of Diet in Renal Disease equation.

Results: 89 of 1439 subjects developed an eGFR <60 ml/min/1.73m2 (Stage 3 CKD) on two or more successive occasions (sustained) during DCCT/EDIC (cumulative incidence: 11.4%). Of these, 20 (24%) had AER <30 mg/24h at all prior evaluations, 14 (16%) had developed microalbuminuria (AER 30-300 mg/24h) before they reached Stage 3 CKD, and 54 (61%) had macroalbuminuria (AER >300 mg/24h) before they reached Stage 3 CKD)., Macroalbuminuria is associated with a markedly increased rate of fall in eGFR (5.7%/year versus 1.2%/year with AER < 30 mg/24hr, p<0.0001) and risk of eGFR <60 ml/min/1.73m2 (adjusted hazard ratio 15.3, p<0.0001) whereas microalbuminuria had weaker and less consistent effects on eGFR.

Conclusions: Macroalbuminuria was a strong predictor of eGFR loss and risk of developing sustained eGFR <60 ml/min/1.73 m2. However, screening with AER alone would have missed 24% of cases of sustained impaired eGFR.

Footnotes

    • Received June 30, 2009.
    • Accepted April 6, 2010.

This Article

  1. Diabetes Care
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