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2017 ; 9
(ä): 68
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Addition of nonalbumin proteinuria to albuminuria improves prediction of type 2
diabetic nephropathy progression
#MMPMID28912839
Kim JH
; Oh SY
; Kim EH
; Lee MJ
; Jeon YK
; Kim BH
; Kim JM
; Kim YK
; Kim SS
; Kim IJ
Diabetol Metab Syndr
2017[]; 9
(ä): 68
PMID28912839
show ga
BACKGROUND: Albuminuria is generally accepted as a sensitive marker of diabetic
nephropathy but has limitations in predicting its progression. The aim of this
study was to evaluate the use of nonalbumin proteinuria in addition to
albuminuria for predicting the progression of type 2 diabetic nephropathy.
METHODS: In this retrospective observational study, the urine
albumin-to-creatinine ratio (ACR) and the nonalbumin protein-to-creatinine ratio
(NAPCR) were measured in 325 patients with type 2 diabetes and estimated
glomerular filtration rates (eGFR) ?30 mL/min/1.73 m(2). The patients were
divided into four groups based on the cutoff points for the urinary ACR (30 mg/g)
and NAPCR (120 mg/g). The renal outcomes were chronic kidney disease (CKD)
progression and accelerated eGFR decline. RESULTS: During the 4.3-year follow-up
period, 25 (7.7%) patients showed CKD progression and 69 (21.2%) patients showed
accelerated eGFR decline. After adjusting for nine clinical parameters, the group
with a NAPCR greater than 120 mg/g exhibited higher cumulative incidences of CKD
progression (hazard ratio 6.84; P = 0.001) and accelerated eGFR decline (hazard
ratio 1.95; P = 0.011) than the group with a NAPCR < 120 mg/g. In patients with
normoalbuminuria, the group with NAPCR levels greater than 120 mg/g also
exhibited a higher cumulative incidence than that with NAPCR levels <120 mg/g of
CKD progression (hazard ratio 21.82; P = 0.005). The addition of NAPCR to ACR
improved the model fit for CKD progression and accelerated eGFR decline.
CONCLUSION: Nonalbumin proteinuria showed additional value over and above that of
albuminuria for predicting the progression of CKD in patients with type 2
diabetes.