Browsing by Author "Jansson, Fanny"

Background: The traditional view of inevitable progression from early albuminuria to end-stage renal disease has recently been challenged in type 1 diabetes. However, the characteristics of regression of albuminuria are not widely understood. Particularly little is known about the clinical consequences of regression. Objective: To assess the rate of albuminuria regression, as well as its impact on cardiovascular disease (CVD) and mortality in type 1 diabetes. Methods: A total of 3,642 individuals from the FinnDiane Study were included. Albuminuria stage was categorized using consensus reference limits in two out of three consecutive measurements to normal range, microalbuminuria, and macroalbuminuria. Regression was defined as a change from a higher category of albuminuria pre-baseline to a lower current stage. Data on CVD and vitality status were retrieved from national registries. Individuals were followed over a median of 14.0 years (IQR 11.9–15.9). Results: Altogether 102 (23.3%) individuals with prior microalbuminuria and 111 (23.4%) with prior macroalbuminuria regressed. With those with normal albumin excretion as reference, the age-adjusted HRs (95% CI) for CVD were 1.42 (0.75-2.68) in individuals with regressed microalbuminuria, 2.62 (1.95-3.54) with sustained microalbuminuria, 3.15 (2.02-4.92) with regressed macroalbuminuria, and 5.49 (4.31-7.00) with sustained macroalbuminuria. Findings were similar for all-cause and cardiovascular mortality. Conclusions: Progression of diabetic nephropathy confers an increased risk of CVD and premature mortality. Notably, regression reduces the risk to the same level as for those who did not progress.