Predictors of Microalbuminuria in Individuals with IDDM: Pittsburgh Epidemiology of Diabetes Complications Study

Beth Ann Coonrod; Demetrius Ellis; Dorothy J Becker; Clareann H Bunker; Sheryl F Kelsey; Cathy E Lloyd; Allan L Drash; Lewis H Kuller; Trevor J Orchard

doi:10.2337/diacare.16.10.1376

Original Articles

Predictors of Microalbuminuria in Individuals with IDDM: Pittsburgh Epidemiology of Diabetes Complications Study

Beth Ann Coonrod, PHD,
Demetrius Ellis, MD,
Dorothy J Becker, MBBCH,
Clareann H Bunker, PHD,
Sheryl F Kelsey, PHD,
Cathy E Lloyd, PHD,
Allan L Drash, MD,
Lewis H Kuller, MD and
Trevor J Orchard, MBBCH

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh Pittsburgh; the Divisions of Nephrology and Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania; and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Bethesda, Maryland

Address correspondence and reprint requests to Trevor J. Orchard, MBBCh, Diabetes Research Center of Children's Hospital of Pittsburgh, Fifth Floor, Rangos Research Center, 3460 Fifth Avenue, Pittsburgh, PA 15213.

Diabetes Care 1993 Oct; 16(10): 1376-1383. https://doi.org/10.2337/diacare.16.10.1376

Abstract

OBJECTIVE To examine the relationships between microalbuminuria and the development of overt diabetic nephrology, elevated blood pressure, and a more atherogenic lipid profile; and to identify risk factors for the development of microalbuminuria in individuals with IDDM. Microalbuminuria has been associated with the subsequent development of overt diabetic nephropathy in individuals with IDDM. It is associated with elevated blood pressure and a more atherogenic lipid profile, but the temporal relationship between the development of microalbuminuria and the changes in these factors is unclear.

RESEARCH DESIGN AND METHODS Baseline characteristics were examined in 256 individuals with IDDM who had normal albumin excretion (urinary AER ≤20 μg/min in ≥2 timed urine collections) and were re-examined 2 yr later.

RESULTS At follow-up, 24 had developed microalbuminuria (AER 20–200 (Ag/min in ≥2 timed urine collections) and 1 had developed overt nephropathy (AER ≥200 μg/min). Overall, the significant independent predictors of microalbuminuria were HbA₁ (P < 0.001), low-density lipoprotein (P < 0.01), duration of IDDM (P < 0.05), and systolic blood pressure (P = 0.05). Sex-specific analyses showed HbA₁ age, and baseline AER were particularly important for men; whereas, for women, the main predictors were duration of IDDM and triglycerides. Duration-specific analyses showed that HbA₁ was an important predictor both for individuals with < and >20-yr duration. Low-density lipoprotein cholesterol was more important for subjects with shorter durations; whereas triglycerides were important for those with longer durations.

CONCLUSIONS These results suggest that glycemic control, age or duration of IDDM, disturbed lipids, and possibly elevated blood pressure all may contribute to the development of microalbuminuria; and, further, that the adverse cardiovascular risk profile seen in individuals with overt nephropathy may begin to develop even before the detection of microalbuminuria.