Assessment of Risk of Overt Nephropathy in Diabetic Patients From Albumin Excretion in Untimed Urine Specimens

doi:10.1001/archinte.1991.00400090057011

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Vol. 151 No. 9, SEPTEMBER 1991

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Assessment of Risk of Overt Nephropathy in Diabetic Patients From Albumin Excretion in Untimed Urine Specimens

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 asingle untimed urine specimen, to indicate the likelihood ofdeveloping overt diabetic nephropathy was determined in 439Pima Indians (134 men, 305 women) aged 25 years or older withnon—insulin-dependent diabetes. During a mean follow-upperiod of 4.2 years, 59 (13%) of the subjects developed overtnephropathy, 47 (80%) of whom had albumin-to-creatinine ratiosof 30 mg/g or greater at baseline. Subjects with albumin-to-creatinineratios 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 withratios of less than 30 mg/g. Furthermore, the albumin-to-creatinineratio remained a strong predictor of overt nephropathy evenwhen controlled for age, sex, diabetes duration, mean bloodpressure, and 2-hour postload plasma glucose concentration witha proportional-hazards function analysis. Thus, an albumin-to-creatinineratio measured in a single untimed urine specimen is an effectivemeans of identifying diabetic subjects who are at risk of developingovert nephropathy that could replace the more traditional timedurine 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 ofthe American Diabetes Association, Atlanta, Ga, June 18, 1990.

Reprints not available.

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