Abstract
Although increased urinary albumin excretion may increase the risk of adverse renal outcomes in patients with diabetes, it remains unclear whether microalbuminuria is associated with a higher incidence of macroalbuminuria in the absence of non-diabetic kidney events that frequently develop during the long-term course of type 2 diabetes. This historical cohort study included patients with type 2 diabetes, spot urine albumin:creatinine ratio (ACR) <300 mg/gCr and normal serum creatinine concentrations treated between August 1988 and April 2015. Patients with any evidence suggesting non-diabetic kidney diseases at baseline were excluded. Over a median follow-up of 50 months, 70 of the 1760 included patients developed macroalbuminuria. Twenty-one of these patients were diagnosed with non-diabetic renal events. The five-year cumulative incidence of macroalbuminuria in patients with ACRs of 0–7.5 mg/gCr, 7.5–30 mg/gCr, 30–150 mg/gCr, and 150–300 mg/gCr were 0%, 0.53%, 3.5%, and 36.0%, respectively, with significant differences between each pair of ACR categories. In type 2 diabetes, higher urinary ACR, even within a level of normoalbuminuria, was associated with a greater incidence of macroalbuminuria when non-diabetic renal events were excluded. These results conflict with findings suggesting that microalbuminuria is a poor indicator for the progression of diabetic nephropathy.
Highlights
IntroductionBecause type 2 diabetes patients often develop kidney injury unrelated to diabetic nephropathy over the long-term, little is known about the contribution of these non-diabetic factors to the development of macroalbuminuria and the decline of renal function
Predicting the future development of clinical nephropathy[25,26]
This study showed that baseline albumin-creatinine ratio (ACR) was associated with an increased incidence of macroalbuminuria in type 2 diabetic patients lacking potentially preexisting non-diabetic kidney diseases
Summary
Because type 2 diabetes patients often develop kidney injury unrelated to diabetic nephropathy over the long-term, little is known about the contribution of these non-diabetic factors to the development of macroalbuminuria and the decline of renal function. This study evaluated whether the risk of incident macroalbuminuria was related to the levels of albuminuria in a historical cohort of type 2 diabetic patients with complete medical records throughout their entire follow-up periods. Since 1988, routine follow-up protocols for diabetic patients covered by the universal health insurance system in Japan have included routine quarterly measurements of albuminuria. Complete records of automated urine analysis and subsequent fluorescent laser flow cytometry analysis of urine sediments provide important clues in detecting and diagnosing non-diabetic kidney diseases and provide information over time, determining whether incident macroalbuminuria or reduced renal function was caused by non-diabetic kidney injury
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