• Eunyoung Lee, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Dong-Ryeol Ryu, Shin-Wook Kang, and Tae-Hyun Yoo.
• From the Department of Internal Medicine, Yonsei University College of Medicine (EL, HJO, JTP, SHH, S-WK, THY), Department of Internal Medicine, School of Medicine, Ewha Womans University (D-RR), and Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University (S-WK), Seoul, Republic of Korea.
• Medicine (Baltimore). 2016 Apr 1; 95 (15): e3175e3175.

AbstractDiabetic kidney disease leads to microalbuminuria and gradually progresses to overt proteinuria with renal insufficiency. Recent studies have demonstrated that 20% to 40% of patients with diabetic kidney disease are normo- to microalbuminuric, despite reduced renal function. We investigated renal and cardiovascular outcomes in patients with diabetes and renal insufficiency who were normo-, micro-, and macroalbuminuric. Patients with diabetes and stage III or IV chronic kidney disease were recruited and divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. New-onset cardiovascular events and renal outcomes, defined by end-stage renal disease or a 50% decline in estimated glomerular filtration rate, were evaluated. Among the 1136 study patients, 255 (22.4%) were normoalbuminuric. During a mean follow-up duration of 44 months, the incidence of cardiovascular disease was similar among groups (P = 0.68). However, renal outcomes were significantly more common in patients with macroalbuminuria than in those who were normoalbuminuric or microalbuminuric (P < 0.001). Multivariate Cox analysis identified macroalbuminuria and estimated glomerular filtration rate as independent predictors of renal outcomes. The amount of albuminuria was not associated with cardiovascular events in this population. Although cardiovascular events were similar in patients with diabetic kidney disease and renal insufficiency, renal outcomes differed significantly according to the amount of albuminuria.

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