There have been no studies that employ longitudinal data with more than two measurements and use methods of longitudinal data analysis to identify risk factors for incident albuminuria over time more effectively.
Settings & Participants
A subgroup of participants in the Strong Heart Study, a population-based sample of American Indians, in central Arizona, Oklahoma, and North and South Dakota. Diabetic participants without albuminuria were followed for a mean of four years.
Age, sex, study center, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, body mass index, systolic blood pressure, use of antihypertensive medication, smoking, hemoglobin A1c, fasting glucose, type of diabetes therapy, diabetes duration, plasma creatinine and urinary albumin/creatinine ratio (UACR).
Outcomes & Measurements
Albuminuria was defined as UACR ≥ 30 mg/g. Urine creatinine and albumin was measured by the picric acid method and a sensitive nephelometric technique, respectively.
Among the 750 and 568 diabetic participants without albuminuria and with normal plasma creatinine at the 1st and 2nd examinations, 246 and 132 developed albuminuria by the 2nd and 3rd examinations, respectively. Incident albuminuria was predicted by baseline UACR, fasting glucose, systolic blood pressure, plasma creatinine, study center, current smoking, and use of angiotensin converting enzyme (ACE) inhibitors and antidiabetic medications. UACR of 10–30 mg/g increased the odds of developing albuminuria 2.7-fold compared with UACR < 5 mg/g.
Single random morning urine specimen.
Many of risk factors identified for incident albuminuria can be modified. The control of blood pressure and glucose, smoking cessation, and use of ACE inhibitors may reduce the incidence of albuminuria.