Eur J Clin Invest 2011; 41 (8): 870–878
Background Asian has higher prevalence of diabetic nephropathy (DN) and end-stage renal disease when compared to Caucasian. No study to date has evaluated whether multifactorial intervention was associated with remission of microalbuminuria in type 2 diabetic Asian population. We evaluated the effect of tightly controlling multiple factors on the remission of DN in type 2 diabetic Chinese with microalbuminuria.
Materials and methods A longitudinal cohort study was collected 587 type 2 diabetic patients with microalbuminuria. Cohort members received intensified treatment to meet the following ADA recommended goals: HbA1c < 7%, systolic blood pressure (SBP) < 130 mmHg, diastolic blood pressure < 80 mmHg, low-density lipoprotein cholesterol < 100 mg dL−1, triglyceride < 150 mg dL−1, high-density lipoprotein cholesterol > 40 mg dL−1 for men and > 50 mg dL−1 for women. Remission of microalbuminuria was defined as shift of albumin–creatinine ratio from mircoalbuminuria to normoalbuminuria.
Results During the 4·5-year period, 210 (35·8%) patients achieved remission to normoalbuminuria. A significant association was found between the achievement of ADA goals, including HbA1c < 7% [hazard ratio (HR) = 1·345; 95% confidence interval (CI), 1·010–1·792; P = 0·04] and SBP < 130 mmHg (HR, 1·516; 95% CI, 1·100–2·089; P = 0·01) and remission of microalbuminuria. The intensive SBP control (< 120mmHg) was significantly associated with remission of microalbuminuria (HR, 2·076; 95% CI, 1·347–3·198; P < 0·001).
Conclusions The remission of DN could be achieved under multifactorial intervention. Therapeutic focus on remission by tight glycemic and blood pressure control should be considered in Asian population with diabetes and microalbuminuria.