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Microalbuminuria in type I diabetic patients. Prevalence and clinical characteristics
Objective:
To estimate the prevalence of microalbuminuria, overnight urinary albumin excretion rate (AER) greater than or equal to 30 and less than or equal to 250 micrograms/min, in a large sequential sample of nonhypertensive insulin-dependent (type I) diabetic patients attending hospital diabetic clinics, to identify micro- and normoalbuminuric patients in this sample for subsequent intervention and natural history follow-up studies, and to compare the clinical characteristics of the micro- and normoalbuminuric patients identified.
Research Design And Methods:
Screening was conducted in two phases. In phase 1, all eligible patients were asked to provide an early morning urine specimen for measurement of albumin concentration and albumin-creatinine ratio. In phase 2, all patients with an albumin concn greater than or equal to 15 mg/L and/or an albumin-creatinine ratio greater than or equal to 3.5 mg/mmol and a random sample of those with an albumin concn less than 15 mg/L and albumin-creatinine ratio less than 3.5 mg/mmol were asked to collect a timed overnight urine specimen for determination of AER.
Results:
Among 1888 patients (16-60 yr old, diabetes onset less than 40 yr, and duration of diabetes less than 35 yr) who were screened, the prevalence of microalbuminuria was approximately 3.7% (95% confidence interval (CI) 2.7-7.6%). Duration of diabetes was significantly longer in micro- than normoalbuminuric patients (20 vs. 15 yr, respectively; P less than 0.001), and in no patient with microalbuminuria was the duration of diabetes less than 5 yr. Systolic and diastolic blood pressures, higher in micro- than normoalbuminuric patients (132 vs. 122 mmHg, P less than 0.01; 77 vs. 72 mmHg, P less than 0.01), were strongly associated with AER.
Conclusions:
Microalbuminuria in type I diabetes, which appears to represent an earlier phase in the development of clinical nephropathy, is associated with elevated blood pressure and a longer duration of diabetes.
Insights
Microalbuminuria, an early sign of diabetic nephropathy, affects 3.7% of type I diabetes patients. It is linked to longer diabetes duration and higher blood pressure.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Background:
- Microalbuminuria is a key indicator of early diabetic kidney disease.
- Identifying microalbuminuria in Type I diabetes is crucial for timely intervention.
- Understanding the prevalence and associated factors is vital for patient management.
Purpose of the Study:
- To determine the prevalence of microalbuminuria in nonhypertensive Type I diabetic patients.
- To identify patients with microalbuminuria for follow-up studies.
- To compare clinical characteristics of microalbuminuric and normoalbuminuric patients.
Main Methods:
- A two-phase screening process was used for albuminuria assessment.
- Early morning urine samples measured albumin concentration and albumin-creatinine ratio.
- Overnight urine samples determined albumin excretion rate (AER) in selected patients.
Main Results:
- Prevalence of microalbuminuria was 3.7% in 1888 Type I diabetic patients.
- Microalbuminuric patients had longer diabetes duration (20 vs. 15 years) and higher blood pressure.
- Elevated blood pressure was strongly associated with AER.
Conclusions:
- Microalbuminuria signifies an early stage of diabetic nephropathy.
- Longer diabetes duration and elevated blood pressure are associated with microalbuminuria.
- These findings aid in identifying patients for intervention and monitoring.