Diabetes and the KidneyDeterminants of Progression from Microalbuminuria to Proteinuria in Patients Who Have Type 1 Diabetes and Are Treated with Angiotensin-Converting Enzyme InhibitorsFicociello, Linda H.; Perkins, Bruce A.; Silva, Kristen H.; Finkelstein, Dianne M.; Ignatowska-Switalska, Halina; Gaciong, Zbigniew; Cupples, L. Adrienne; Aschengrau, Ann; Warram, James H.; Krolewski, Andrzej S. Author Information *Research Division, Joslin Diabetes Center, †Department of Medicine, Harvard Medical School, §Massachusetts General Hospital Cancer Center, and ¶School of Public Health, Boston University, Boston, Massachusetts; ‡Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada; and ‖Division of Internal Medicine and Hypertension, Warsaw Medical University, Warsaw, Poland Address correspondence to: Dr. Andrzej S. Krolewski, Section on Genetics & Epidemiology, Joslin Diabetes Center, One Joslin Place, Room 368, Boston, MA 02215. Phone: 617-732-2668; Fax: 617-732-2667; E-mail: [email protected] Accepted February 14, 2007 Received November 8, 2006 Clinical Journal of the American Society of Nephrology 2(3):p 461-469, May 2007. | DOI: 10.2215/CJN.03691106 Buy Metrics Abstract The aims of this study were to assess the frequency and determinants of (1) treatment with angiotensin-converting enzyme inhibitors (ACE-I) and (2) progression to proteinuria in the presence of ACE-I treatment in patients with type 1 diabetes and microalbuminuria. A clinic-based cohort study of patients with type 1 diabetes was begun in 1991. The patients who were included in this study (n = 373) are the cohort members who received a diagnosis of microalbuminuria during a 2-yr baseline observation and were followed for 10 yr with frequent assessments of urinary albumin excretion and biennial examinations. Progression to proteinuria occurred when the median urinary albumin excretion during a 2-yr interval exceeded 299 μg/min. During the decade-long study, the proportion of patients who had a history of microalbuminuria and were treated with ACE-I rose from 17 to 67%. Patients who started this treatment had (on average) higher BP, higher urinary albumin excretion, and longer diabetes duration than those who did not. Microalbuminuria often progressed to proteinuria (6.3/100 person-years) in those who were treated. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors of this progression. Although treatment with ACE-I increased during the past decade, it was not completely effective, because microalbuminuria progressed to proteinuria in many treated patients. Poor glycemic control and elevated serum cholesterol were the major determinants/predictors for progression while on ACE-I treatment. The mechanisms that are responsible for the frequent failure of ACE-I to prevent progression of microalbuminuria to proteinuria in a clinical setting are not clear. Copyright © 2007 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.