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Robert G. Nelson, MD, MPH; William C. Knowler, MD, DrPH; David J. Pettitt, MD; Mohammed F. Saad, MD, MRCP; Marie A. Charles, MD; Peter H. Bennett, MB, FRCP, FFCM

Arch Intern Med. 1991;151(9):1761-1765.

Abstract
The ability of an albumin-to-creatinine ratio, measured in a single untimed urine specimen, to indicate the likelihood of developing overt diabetic nephropathy was determined in 439 Pima Indians (134 men, 305 women) aged 25 years or older with non—insulin-dependent diabetes. During a mean follow-up period of 4.2 years, 59 (13%) of the subjects developed overt nephropathy, 47 (80%) of whom had albumin-to-creatinine ratios of 30 mg/g or greater at baseline. Subjects with albumin-to-creatinine ratios of 30 to 299 mg/g (a level of excretion often termed "microalbuminuria") had 9.2 times (95% confidence interval, 4.4 to 21.4 the incidence of overt nephropathy of those with ratios of less than 30 mg/g. Furthermore, the albumin-to-creatinine ratio remained a strong predictor of overt nephropathy even when controlled for age, sex, diabetes duration, mean blood pressure, and 2-hour postload plasma glucose concentration with a proportional-hazards function analysis. Thus, an albumin-to-creatinine ratio measured in a single untimed urine specimen is an effective means of identifying diabetic subjects who are at risk of developing overt nephropathy that could replace the more traditional timed urine collections.

(Arch Intern Med. 1991;151:1761-1765)

Author Affiliations
From the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation (Dr Nelson), and the Diabetes and Arthritis Epidemiology Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases (Drs Knowler, Pettitt, Saad, Charles, and Bennett), Phoenix, Ariz.

Footnotes
Accepted for publication February 18, 1991.

Presented in part at the 50th Annual Scientific Sessions of the American Diabetes Association, Atlanta, Ga, June 18, 1990.

Reprints not available.

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