The American Journal of Medicine
Volume 122, Issue 1 , Pages 62-72, January 2009

The Natural Course of Microalbuminuria among African Americans with Type 2 Diabetes: A 3-Year Study

Data related to this manuscript were presented during the International Congress of Nephrology at Rio de Janeiro, Brazil in April 2007.

  • Mohamed G. Atta, MD, MPH

      Affiliations

    • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
    • Corresponding Author InformationRequests for reprints should be addressed to Mohamed G. Atta, MD, MPH, 1830 E. Monument Street, Suite 416, Baltimore, MD 21287
    • ,
  • Kesha Baptiste-Roberts, PhD, MPH

      Affiliations

    • Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Frederick L. Brancati, MD, MHS

      Affiliations

    • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
    • Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Md
    • ,
  • Tiffany L. Gary, PhD

      Affiliations

    • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
    • Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Md

Abstract 

Background

The natural course of microalbuminuria in African Americans (AA) with type 2 diabetes is not well established.

Method

Longitudinal analysis of 186 African Americans with type 2 diabetes enrolled in Project Sugar, a randomized controlled trial of primary care-based interventions to improve diabetes control.

Results

Mean age was 59.4 years and 85% were female. Mean estimated glomerular filtration rate and urinary albumin-to-creatinine ratio were 75.90 mL/min/1.73 m2 and 1.62, respectively. Thirty-nine patients had macroalbuminuria and significantly higher systolic blood pressure compared with those with microalbuminuria (P=.01). Sixty patients had microalbuminuria, 19 progressed to macroalbuminuria, and none regressed. Progression was associated significantly with systolic blood pressure ≥115 mm Hg and requirement for blood pressure medication in the univariate model. In the multivariate model, the degree of albumin-to-creatinine ratio (odds ratio 35.51, 95% confidence interval, 2.21-571.65) and need for blood pressure medication (odds ratio 8.96, 95% confidence interval, 1.35-59.70) were independently associated with progression. No association was observed with the use of specific antihypertensive agent.

Conclusion

This study suggests that African Americans with type 2 diabetes and microalbuminuria experience irreversible disease that not infrequently progresses to overt proteinuria. The degree of microalbuminuria and blood pressure are key determinants in this process and should be primary targets in treating this population regardless of the antihypertensive class used.

Keywords: African Americans, Microalbuminuria, Nephropathy, Type 2 diabetes

 

 Funding: The project was funded by grants from the National Institutes of Health (R01-DK48117 and R00052). Dr. Gary was funded by a grant from the NHLBI (K01-HL084700) and Dr. Brancati was funded by a grant from the NIDDK (K24-DK6222).

 Conflict of Interest: None.

 Authorship: All authors had access to the data and a role in writing the manuscript.

PII: S0002-9343(08)00850-4

doi:10.1016/j.amjmed.2008.07.023

The American Journal of Medicine
Volume 122, Issue 1 , Pages 62-72, January 2009

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