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Abstract

Click to add/remove this article to your list of 'My Favorites' 5-year Change in Urinary Albumin Excretion Rate (AER) in the Insulin Resistance and Atherosclerosis Study (IRAS)

Year: 2004

Abstract Number: 1003-P

Authors: ANDREW J. KARTER, DANIEL J. ZACCARO, LYNNE E. WAGENKNECHT, ASSIAMIRA FERRARA, STEVE M. HAFFNER

Institutions: Oakland, CA; Winston-Salem, NC; San Antonio, TX

Results: Elevated AER is a potent cardiovascular risk factor and marker of diabetic nephropathy. AER screening is routinely conducted in diabetes care, although not in non-diabetic subjects. The natural history of AER, particularly in normoglycemic (NGT) and impaired glucose tolerance (IGT) subjects, is poorly understood. We studied 5-year changes in AER status in African American, Hispanic and non-Hispanic white subjects classified at baseline with NGT (n=591), IGT (n=292), newly diagnosed (DM-new; n=142) and prevalent (DM-prev; n=247) type 2 diabetes, from the Insulin Resistance Atherosclerosis Study. AER status was categorized as normoalbuminuric (N) if urine albumin:creatinine ratio<30 mg/g, microalbuminuria (MA) if 30-299 mg/g and proteinuria (P) if >300 mg/g. AER status was assessed at baseline (1992-94) and follow-up (1998-99) exams. Baseline prevalence of elevated AER (MA or P) was 6% in NGT, 6% in IGT, 16% in DM-new, and 23% in DM-prev. Five-year cumulative incidence of elevated AER (among those N at baseline) was 6% in NGT, 7% in IGT, % in DM-new, and 23% in DM-prev. Forty-nine percent of subjects with elevated AER at baseline reverted to N at follow-up. In conclusion, a) nephropathy risk is not elevated in pre-diabetes, but increases steeply after the onset of diabetes; b) normalization of elevated AER is common; and c) AER has low predictive value and should be considered potentially transient and modifiable.

Five-year transition of AER status
BASELINE5-YEAR FOLLOW-UP AER STATUS
Glucose tolerance status (n)Urinary albumin status (%)Normoalbuminuria (%)Microalbuminuria (%)Proteinuria (%)
Normoglycemic (591)N (94)8950
MA (6)420
P (0)000
IGT (292)N (94)8860
MA (5)221
P (1)00.30.3
Diabetes-new (142)N (84)71121
MA (14)680
P (2)002
Diabetes-prevalent (247)N (77)59153
MA (19)1163
P (4)022
*Percentages add to 100% within each glycemic strata; IGT=Impaired Glucose Tolerance; N = Normoalbuminuria; MA = Microalbuminuria; P = Proteinuria

Category: Epidemiology

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