Table 3.
Risk factors for long-term renal outcomes after the diagnosis of persistent microalbuminuria among 325 participants in the DCCT/EDIC Study
| Renal outcomes | ||||||
|---|---|---|---|---|---|---|
| Macroalbuminuria | Impaired GFR | Normoalbuminuria | ||||
| Risk factor | HR (95% CI) | p | HR (95% CI) | p | HR (95% CI) | p |
| Assessed at PMA diagnosis | ||||||
| Age (per year) | 1.00 (0.98–1.02) | 0.94 | 1.04 (1.01–1.07) | 0.01 | 1.00 (0.98–1.02) | 0.84 |
| Female gender | 0.52 (0.33–0.82) | 0.005 | 1.10 (0.65–1.87) | 0.73 | 2.53 (1.70–3.76) | <0.001 |
| Duration of diabetes (years) | ||||||
| < 10 years | 0.62 (0.38–1.02) | 0.06 | 0.54 (0.28–1.06) | 0.07 | 1.60 (1.04–2.45) | 0.03 |
| 10 –19 years | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | |||
| ≥ 20 years | 0.27 (0.06–1.11) | 0.07 | 0.89 (0.31–2.59) | 0.84 | 1.38 (0.62–3.09) | 0.43 |
| DCCT intensive diabetes therapy | 0.64 (0.4–1.02) | 0.06 | 0.65 (0.36–1.16) | 0.14 | 1.92 (1.28–2.86) | 0.002 |
| Retinopathy | 3.15 (1.09–9.11) | 0.03 | 2.83 (0.64–12.5) | 0.17 | 0.46 (0.24–0.87) | 0.02 |
| Active smoking | 1.13 (0.73–1.75) | 0.57 | 1.04 (0.60–1.81) | 0.90 | 1.33 (0.87–2.03) | 0.19 |
| RAAS inhibitor use | 0.57 (0.17–1.94) | 0.37 | 1.17 (0.38–3.54) | 0.79 | 0.59 (0.14–2.57) | 0.49 |
| Lipid-lowering medication use | 2.16 (0.8–5.83) | 0.13 | 2.52 (0.84–7.55) | 0.10 | 1.04 (0.29–3.76) | 0.95 |
| Body mass index (per kg/m2) | 1.01 (0.96–1.07) | 0.64 | 0.95 (0.88–1.02) | 0.18 | 0.96 (0.91–1.01) | 0.13 |
| Systolic BP (per 10 mmHg) | 1.30 (1.10–1.54) | 0.003 | 1.06 (0.86–1.30) | 0.60 | 0.85 (0.72–0.99) | 0.04 |
| Diastolic BP (per 10 mmHg) | 1.38 (1.08–1.77) | 0.01 | 1.21 (0.89–1.65) | 0.23 | 0.71 (0.56–0.90) | 0.004 |
| Hemoglobin A1c (per %) | 1.25 (1.11–1.40) | <0.001 | 1.33 (1.15–1.53) | <0.001 | 0.76 (0.67–0.85) | <0.001 |
| Total cholesterol (per 10 mg/dL) | 1.14 (1.05–1.23) | 0.001 | 1.07 (0.97–1.18) | 0.16 | 0.88 (0.82–0.94) | <0.001 |
| HDL cholesterol (per 10 mg/dL) | 1.10 (0.85–1.42) | 0.48 | 1.21 (0.87–1.67) | 0.26 | 0.96 (0.78–1.18) | 0.69 |
| Triglycerides (per 10 mg/dL) | 1.06 (1.01–1.10) | 0.01 | 1.04 (0.98–1.10) | 0.15 | 0.93 (0.87–0.98) | 0.007 |
| LDL cholesterol (per 10 mg/dL) | 1.12 (1.03–1.22) | 0.01 | 1.04 (0.93–1.16) | 0.52 | 0.88 (0.82–0.95) | 0.001 |
| AER | ||||||
| 30–49 | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | |||
| 50–99 | 1.98 (1.23–3.18) | 0.005 | 1.42 (0.75–2.69) | 0.28 | 0.85 (0.54–1.36) | 0.50 |
| ≥ 100 | 3.33 (1.95–5.69) | <0.001 | 3.17 (1.69–5.93) | <0.001 | 0.70 (0.40–1.25) | 0.23 |
| Time-updated risk factors | ||||||
| Systolic BP (per 10 mmHg) | 1.71 (1.49–1.97) | <0.001 | 1.91 (1.65–2.21) | <0.001 | 0.82 (0.70–0.95) | 0.008 |
| Diastolic BP (per 10 mmHg) | 2.03 (1.63–2.53) | <0.001 | 2.17 (1.67–2.82) | <0.001 | 0.68 (0.55–0.84) | <0.001 |
| Hemoglobin A1c (per %) | 1.25 (1.1–1.42) | <0.001 | 1.13 (0.95–1.33) | 0.16 | 0.79 (0.69–0.90) | <0.001 |
HR = hazard ratio, adjusted for age, gender, and duration of diabetes at the time of persistent microalbuminuria diagnosis; CI = confidence interval; PMA = persistent microalbuminuria; RAAS = renin-angiotensin-aldosterone system.