The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study
The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study. The purpose of this study was to examine the relationship between glomerular filtration rate (GFR) measured at 5 years' diabetes duration and annual...
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| Veröffentlicht in: | Kidney international 2005-10, Vol.68 (4), p.1740-1749 |
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| creator | Amin, Rakesh Turner, Charles van Aken, Sara Konopelska Bahu, Teresa Watts, Angela Lindsell, David R.M. Neil Dalton, R. Dunger, David B. |
| description | The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study.
The purpose of this study was to examine the relationship between glomerular filtration rate (GFR) measured at 5 years' diabetes duration and annual urine albumin excretion in a prospective cohort of children with type 1 diabetes (T1DM).
Three hundred and eight children were followed from diagnosis of T1DM [aged 9.8 years (range 0.4-15.9) for a median duration of 10.9 years (6.0-17.8) with annual assessments comprising measurement of HbA1c and 3 urine samples for albumin:creatinine ratio (ACR). GFR was measured in all children at 5 years' diabetes duration.
Two hundred forty-three (78.8%) subjects were normoalbuminuric (MA-) for the duration of the study. At 5 years: 35 (11.4%) subjects had MA (MA+) and 30 (9.7%) subjects were normoalbuminuric but developed MA during subsequent follow-up annual assessments (future MA+). In the future MA+ group compared to the MA+ and MA- groups; GFR was higher (167 vs. 134 vs. 139 mL/min/1.73m2, P < 0.002); the prevalence of hyperfiltration (GFR >125 mL/min/1.73m2) was greater (97 vs. 57 vs. 64%, P = 0.006) and HbA1c levels were higher (11.4 vs. 10.8 vs. 9.7%, P < 0.001). The probability (Cox Model) of having hyperfiltration at 5 years' duration was related to puberty (a 1.7-fold increased risk with puberty onset) and poor glycemic control (a 10% increased risk for a 1% increase in HbA1c). Comparing subjects with and without hyperfiltration, prior to the first GFR measurement no difference in ACR levels existed; however, after this time median ACR levels were significantly greater [1.2 (0.1-86.4) vs. 0.9 (0.1-71.6) mg/mmol, P = 0.003], independent of age and HbA1c levels. The probability of developing MA between 5 and 10 years' duration was associated with poor glycemic control (a 30% increased risk for a 1% increase in HbA1c) and higher GFR at 5 years (22% increased risk for a 10 mL/min/1.73m2 rise in GFR).
Glomerular hyperfiltration is associated with puberty and increasing ACR levels and is predictive of MA independent of HbA1c. This suggests that factors other than poor glycemic control may be involved in the pathogenesis of early diabetic nephropathy and early intervention with medical therapy to reduce GFR may be beneficial even before onset of MA. |
| doi_str_mv | 10.1111/j.1523-1755.2005.00590.x |
| format | Article |
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The purpose of this study was to examine the relationship between glomerular filtration rate (GFR) measured at 5 years' diabetes duration and annual urine albumin excretion in a prospective cohort of children with type 1 diabetes (T1DM).
Three hundred and eight children were followed from diagnosis of T1DM [aged 9.8 years (range 0.4-15.9) for a median duration of 10.9 years (6.0-17.8) with annual assessments comprising measurement of HbA1c and 3 urine samples for albumin:creatinine ratio (ACR). GFR was measured in all children at 5 years' diabetes duration.
Two hundred forty-three (78.8%) subjects were normoalbuminuric (MA-) for the duration of the study. At 5 years: 35 (11.4%) subjects had MA (MA+) and 30 (9.7%) subjects were normoalbuminuric but developed MA during subsequent follow-up annual assessments (future MA+). In the future MA+ group compared to the MA+ and MA- groups; GFR was higher (167 vs. 134 vs. 139 mL/min/1.73m2, P < 0.002); the prevalence of hyperfiltration (GFR >125 mL/min/1.73m2) was greater (97 vs. 57 vs. 64%, P = 0.006) and HbA1c levels were higher (11.4 vs. 10.8 vs. 9.7%, P < 0.001). The probability (Cox Model) of having hyperfiltration at 5 years' duration was related to puberty (a 1.7-fold increased risk with puberty onset) and poor glycemic control (a 10% increased risk for a 1% increase in HbA1c). Comparing subjects with and without hyperfiltration, prior to the first GFR measurement no difference in ACR levels existed; however, after this time median ACR levels were significantly greater [1.2 (0.1-86.4) vs. 0.9 (0.1-71.6) mg/mmol, P = 0.003], independent of age and HbA1c levels. The probability of developing MA between 5 and 10 years' duration was associated with poor glycemic control (a 30% increased risk for a 1% increase in HbA1c) and higher GFR at 5 years (22% increased risk for a 10 mL/min/1.73m2 rise in GFR).
Glomerular hyperfiltration is associated with puberty and increasing ACR levels and is predictive of MA independent of HbA1c. This suggests that factors other than poor glycemic control may be involved in the pathogenesis of early diabetic nephropathy and early intervention with medical therapy to reduce GFR may be beneficial even before onset of MA.</description><identifier>ISSN: 0085-2538</identifier><identifier>EISSN: 1523-1755</identifier><identifier>DOI: 10.1111/j.1523-1755.2005.00590.x</identifier><identifier>PMID: 16164650</identifier><identifier>CODEN: KDYIA5</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Albuminuria - epidemiology ; Albuminuria - pathology ; Albuminuria - physiopathology ; Biological and medical sciences ; blood pressure ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1 - epidemiology ; Diabetes. Impaired glucose tolerance ; Diabetic Nephropathies - epidemiology ; Diabetic Nephropathies - pathology ; Diabetic Nephropathies - physiopathology ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; GFR ; Glomerular Filtration Rate - physiology ; HbA1c ; Humans ; hyperfiltration ; Infant ; Kidney - pathology ; Kidney - physiopathology ; Longitudinal Studies ; Male ; Medical sciences ; microalbuminuria ; Nephrology. Urinary tract diseases ; Prevalence ; Prospective Studies ; Puberty ; Risk Factors ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland</subject><ispartof>Kidney international, 2005-10, Vol.68 (4), p.1740-1749</ispartof><rights>2005 International Society of Nephrology</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Oct 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c545t-7b7bd4166a874a68d1949c7e20370682a8286d67886e994782dc442be67bf5d33</citedby><cites>FETCH-LOGICAL-c545t-7b7bd4166a874a68d1949c7e20370682a8286d67886e994782dc442be67bf5d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17136993$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16164650$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amin, Rakesh</creatorcontrib><creatorcontrib>Turner, Charles</creatorcontrib><creatorcontrib>van Aken, Sara</creatorcontrib><creatorcontrib>Konopelska Bahu, Teresa</creatorcontrib><creatorcontrib>Watts, Angela</creatorcontrib><creatorcontrib>Lindsell, David R.M.</creatorcontrib><creatorcontrib>Neil Dalton, R.</creatorcontrib><creatorcontrib>Dunger, David B.</creatorcontrib><title>The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study</title><title>Kidney international</title><addtitle>Kidney Int</addtitle><description>The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study.
The purpose of this study was to examine the relationship between glomerular filtration rate (GFR) measured at 5 years' diabetes duration and annual urine albumin excretion in a prospective cohort of children with type 1 diabetes (T1DM).
Three hundred and eight children were followed from diagnosis of T1DM [aged 9.8 years (range 0.4-15.9) for a median duration of 10.9 years (6.0-17.8) with annual assessments comprising measurement of HbA1c and 3 urine samples for albumin:creatinine ratio (ACR). GFR was measured in all children at 5 years' diabetes duration.
Two hundred forty-three (78.8%) subjects were normoalbuminuric (MA-) for the duration of the study. At 5 years: 35 (11.4%) subjects had MA (MA+) and 30 (9.7%) subjects were normoalbuminuric but developed MA during subsequent follow-up annual assessments (future MA+). In the future MA+ group compared to the MA+ and MA- groups; GFR was higher (167 vs. 134 vs. 139 mL/min/1.73m2, P < 0.002); the prevalence of hyperfiltration (GFR >125 mL/min/1.73m2) was greater (97 vs. 57 vs. 64%, P = 0.006) and HbA1c levels were higher (11.4 vs. 10.8 vs. 9.7%, P < 0.001). The probability (Cox Model) of having hyperfiltration at 5 years' duration was related to puberty (a 1.7-fold increased risk with puberty onset) and poor glycemic control (a 10% increased risk for a 1% increase in HbA1c). Comparing subjects with and without hyperfiltration, prior to the first GFR measurement no difference in ACR levels existed; however, after this time median ACR levels were significantly greater [1.2 (0.1-86.4) vs. 0.9 (0.1-71.6) mg/mmol, P = 0.003], independent of age and HbA1c levels. The probability of developing MA between 5 and 10 years' duration was associated with poor glycemic control (a 30% increased risk for a 1% increase in HbA1c) and higher GFR at 5 years (22% increased risk for a 10 mL/min/1.73m2 rise in GFR).
Glomerular hyperfiltration is associated with puberty and increasing ACR levels and is predictive of MA independent of HbA1c. This suggests that factors other than poor glycemic control may be involved in the pathogenesis of early diabetic nephropathy and early intervention with medical therapy to reduce GFR may be beneficial even before onset of MA.</description><subject>Adolescent</subject><subject>Albuminuria - epidemiology</subject><subject>Albuminuria - pathology</subject><subject>Albuminuria - physiopathology</subject><subject>Biological and medical sciences</subject><subject>blood pressure</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Diabetes Mellitus, Type 1 - epidemiology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Nephropathies - epidemiology</subject><subject>Diabetic Nephropathies - pathology</subject><subject>Diabetic Nephropathies - physiopathology</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>GFR</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>HbA1c</subject><subject>Humans</subject><subject>hyperfiltration</subject><subject>Infant</subject><subject>Kidney - pathology</subject><subject>Kidney - physiopathology</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>microalbuminuria</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Puberty</subject><subject>Risk Factors</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. 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Impaired glucose tolerance</topic><topic>Diabetic Nephropathies - epidemiology</topic><topic>Diabetic Nephropathies - pathology</topic><topic>Diabetic Nephropathies - physiopathology</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>GFR</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>HbA1c</topic><topic>Humans</topic><topic>hyperfiltration</topic><topic>Infant</topic><topic>Kidney - pathology</topic><topic>Kidney - physiopathology</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>microalbuminuria</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Puberty</topic><topic>Risk Factors</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amin, Rakesh</creatorcontrib><creatorcontrib>Turner, Charles</creatorcontrib><creatorcontrib>van Aken, Sara</creatorcontrib><creatorcontrib>Konopelska Bahu, Teresa</creatorcontrib><creatorcontrib>Watts, Angela</creatorcontrib><creatorcontrib>Lindsell, David R.M.</creatorcontrib><creatorcontrib>Neil Dalton, R.</creatorcontrib><creatorcontrib>Dunger, David B.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Kidney international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amin, Rakesh</au><au>Turner, Charles</au><au>van Aken, Sara</au><au>Konopelska Bahu, Teresa</au><au>Watts, Angela</au><au>Lindsell, David R.M.</au><au>Neil Dalton, R.</au><au>Dunger, David B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study</atitle><jtitle>Kidney international</jtitle><addtitle>Kidney Int</addtitle><date>2005-10-01</date><risdate>2005</risdate><volume>68</volume><issue>4</issue><spage>1740</spage><epage>1749</epage><pages>1740-1749</pages><issn>0085-2538</issn><eissn>1523-1755</eissn><coden>KDYIA5</coden><abstract>The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study.
The purpose of this study was to examine the relationship between glomerular filtration rate (GFR) measured at 5 years' diabetes duration and annual urine albumin excretion in a prospective cohort of children with type 1 diabetes (T1DM).
Three hundred and eight children were followed from diagnosis of T1DM [aged 9.8 years (range 0.4-15.9) for a median duration of 10.9 years (6.0-17.8) with annual assessments comprising measurement of HbA1c and 3 urine samples for albumin:creatinine ratio (ACR). GFR was measured in all children at 5 years' diabetes duration.
Two hundred forty-three (78.8%) subjects were normoalbuminuric (MA-) for the duration of the study. At 5 years: 35 (11.4%) subjects had MA (MA+) and 30 (9.7%) subjects were normoalbuminuric but developed MA during subsequent follow-up annual assessments (future MA+). In the future MA+ group compared to the MA+ and MA- groups; GFR was higher (167 vs. 134 vs. 139 mL/min/1.73m2, P < 0.002); the prevalence of hyperfiltration (GFR >125 mL/min/1.73m2) was greater (97 vs. 57 vs. 64%, P = 0.006) and HbA1c levels were higher (11.4 vs. 10.8 vs. 9.7%, P < 0.001). The probability (Cox Model) of having hyperfiltration at 5 years' duration was related to puberty (a 1.7-fold increased risk with puberty onset) and poor glycemic control (a 10% increased risk for a 1% increase in HbA1c). Comparing subjects with and without hyperfiltration, prior to the first GFR measurement no difference in ACR levels existed; however, after this time median ACR levels were significantly greater [1.2 (0.1-86.4) vs. 0.9 (0.1-71.6) mg/mmol, P = 0.003], independent of age and HbA1c levels. The probability of developing MA between 5 and 10 years' duration was associated with poor glycemic control (a 30% increased risk for a 1% increase in HbA1c) and higher GFR at 5 years (22% increased risk for a 10 mL/min/1.73m2 rise in GFR).
Glomerular hyperfiltration is associated with puberty and increasing ACR levels and is predictive of MA independent of HbA1c. This suggests that factors other than poor glycemic control may be involved in the pathogenesis of early diabetic nephropathy and early intervention with medical therapy to reduce GFR may be beneficial even before onset of MA.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16164650</pmid><doi>10.1111/j.1523-1755.2005.00590.x</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Albuminuria - epidemiology Albuminuria - pathology Albuminuria - physiopathology Biological and medical sciences blood pressure Child Child, Preschool Diabetes Mellitus, Type 1 - epidemiology Diabetes. Impaired glucose tolerance Diabetic Nephropathies - epidemiology Diabetic Nephropathies - pathology Diabetic Nephropathies - physiopathology Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female GFR Glomerular Filtration Rate - physiology HbA1c Humans hyperfiltration Infant Kidney - pathology Kidney - physiopathology Longitudinal Studies Male Medical sciences microalbuminuria Nephrology. Urinary tract diseases Prevalence Prospective Studies Puberty Risk Factors Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland |
| title | The relationship between microalbuminuria and glomerular filtration rate in young type 1 diabetic subjects: The Oxford Regional Prospective Study |
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