Determinants of progression from microalbuminuria to proteinuria in patients who have type 1 diabetes and are treated with angiotensin-converting enzyme inhibitors.

@article{citeulike:2897546, abstract = {The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 mug/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67\%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear.}, address = {Research Division, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.}, author = {Ficociello, L. H. and Perkins, B. A. and Silva, K. H. and Finkelstein, D. M. and Ignatowska-Switalska, H. and Gaciong, Z. and Cupples, L. A. and Aschengrau, A. and Warram, J. H. and Krolewski, A. S. }, citeulike-article-id = {2897546}, doi = {http://dx.doi.org/10.2215/CJN.03691106}, issn = {1555-905X}, journal = {Clinical journal of the American Society of Nephrology : CJASN}, keywords = {acei, dn, proteinuria}, month = {May}, number = {3}, pages = {461--469}, posted-at = {2008-06-16 05:32:42}, priority = {2}, title = {Determinants of progression from microalbuminuria to proteinuria in patients who have type 1 diabetes and are treated with angiotensin-converting enzyme inhibitors.}, url = {http://dx.doi.org/10.2215/CJN.03691106}, volume = {2}, year = {2007} }

TY - JOUR ID - citeulike:2897546 L3 - citeulike-article-id:2897546 TI - Determinants of progression from microalbuminuria to proteinuria in patients who have type 1 diabetes and are treated with angiotensin-converting enzyme inhibitors. JF - Clinical journal of the American Society of Nephrology : CJASN VL - 2 IS - 3 SP - 461 EP - 469 AD - Research Division, Joslin Diabetes Center, Boston, Massachusetts 02215, USA. SN - 1555-905X N2 - The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 mug/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear. KW - acei KW - dn KW - proteinuria AU - Ficociello, LH AU - Perkins, BA AU - Silva, KH AU - Finkelstein, DM AU - Ignatowska-Switalska, H AU - Gaciong, Z AU - Cupples, LA AU - Aschengrau, A AU - Warram, JH AU - Krolewski, AS PY - 2007/05// UR - http://dx.doi.org/10.2215/CJN.03691106 ER -