Determinants of progression of microalbuminuria in patients with NIDDM - A prospective study

被引:54
作者
Smulders, YM
Rakic, M
Stehouwer, CDA
Weijers, RNM
Slaats, EH
Silberbusch, J
机构
[1] ONZE LIEVE VROUW HOSP,DEPT CLIN CHEM,NL-1090 HM AMSTERDAM,NETHERLANDS
[2] VRIJE UNIV AMSTERDAM,ACAD ZIEKENHUIS,INST CARDIOVASC RES,AMSTERDAM,NETHERLANDS
[3] VRIJE UNIV AMSTERDAM,ACAD ZIEKENHUIS,DEPT MED,AMSTERDAM,NETHERLANDS
基金
中国国家自然科学基金;
关键词
D O I
10.2337/diacare.20.6.999
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To assess the degree of interindividual variation in the rate of progression of microalbuminuria and to identify determinants of progression of microalbuminuria in patients with NIDDM. RESEARCH DESIGN AND METHODS - In a prospective cohort study, 58 microalbuminuric NIDDM patients were followed for a period of at least 24 months. During this period, the level of microalbuminuria in these patients was assessed in triplicate 24-h urine samples on at least four separate visits. All patients had stable metabolic control and controlled blood pressure during follow-up. Microalbuminuria was defined as an albumin-to-creatinine ratio in 24-h urine of between 3 and 30 mg/mmol. The individual rates of progression of microalbuminuria were calculated from linear regression analysis. At baseline, the following data were collected for all patients: age, sex, ethnicity, time since diagnosis of NIDDM, smoking habits, drug use, blood pressure, BMI, HbA(1c), serum creatinine, cholesterol, triglyceride, and HDL cholesterol concentrations. RESULTS - Microalbuminuria nas found to progress linearly in time. Considerable differences in rates of progression of microalbuminuria were found, the absolute yearly change in albumin-to-creatinine ratio ranging from -5.2 to 12.9 mg/mmol. In bivariate analyses, serum triglyceride concentration, use of ACE inhibitors, mean arterial blood pressure, HDL cholesterol, and time since diagnosis of NIDDM correlated with progression of microalbuminuria (P less than or equal to 0.05). In stepwise multiple regression analysis, a high triglyceride-to-HDL cholesterol ratio at baseline (P = 0.006) and the use of ACE inhibitors (P = 0.007) were identified as the only independent predictors of progression of microalbuminuria. CONCLUSIONS - The rate of progression of microalbuminuria in NIDDM differs considerably between subjects. Diabetic dyslipidemia (high serum triglyceride and low HDL cholesterol) is a predictor of more rapid progression of microalbuminuria in patients with well-controlled blood pressure.
引用
收藏
页码:999 / 1005
页数:7
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