{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:56:44Z","timestamp":1788919004793,"version":"build-2803163510"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n Background and objectives<\/jats:title>\n In trials of people with type 2 diabetes, albuminuria reduction with renin-angiotensin system inhibitors is associated with lower risks of cardiovascular events and CKD progression. We tested whether progression or remission of microalbuminuria is associated with cardiovascular and renal risk in a well characterized cohort of type 1 diabetes.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We studied 1441 participants in the Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications study. Albumin excretion rate (AER) was quantified annually or biennially for up to 30 years. For each participant, albuminuria status was defined over time as normoalbuminuria (AER continuously <30 mg\/d), sustained microalbuminuria (AER, 30\u2013299 mg\/d on two consecutive visits), macroalbuminuria (AER\u2265300 mg\/d), or remitted microalbuminuria (transition from sustained microalbuminuria to AER<30 mg\/d on two consecutive visits). We tested associations of time-updated albuminuria status with adjudicated clinical cardiovascular events, the development of reduced GFR (<60 ml\/min per 1.73 m\n 2<\/jats:sup>\n on two consecutive visits), and subclinical cardiovascular disease.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At least one cardiovascular event occurred in 184 participants, and 98 participants developed reduced eGFR. Compared with normoalbuminuria, sustained microalbuminuria, remitted microalbuminuria, and macroalbuminuria were each associated with higher risk of cardiovascular events (adjusted hazard ratios [HRs] and 95% confidence intervals [95% CIs]: 1.79 [1.13 to 2.85], 2.62 [1.68 to 4.07], and 2.65 [1.68 to 4.19], respectively) and reduced eGFR (adjusted HRs [95% CIs], 5.26 [2.43 to 11.41], 4.36 [1.80 to 10.57], and 54.35 [30.79 to 95.94], respectively). Compared with sustained microalbuminuria, remission to normoalbuminuria was not associated with reduced risk of cardiovascular events (adjusted HR, 1.33; 95% CI, 0.68 to 2.59) or reduced eGFR (adjusted HR, 1.75; 95% CI, 0.56 to 5.49). Compared with normoalbuminuria, sustained microalbuminuria, remitted microalbuminuria, and macroalbuminuria were associated with greater carotid intima-media thickness, and macroalbuminuria was associated with a greater degree of coronary artery calcification.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In type 1 diabetes, microalbuminuria and macroalbuminuria are associated with higher risks of cardiovascular disease and reduced eGFR, but achieving a remission of established microalbuminuria to normoalbuminuria does not appear to improve outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.02870316","type":"journal-article","created":{"date-parts":[[2016,10,24]],"date-time":"2016-10-24T22:29:33Z","timestamp":1477348173000},"page":"1969-1977","source":"Crossref","is-referenced-by-count":108,"title":["Albuminuria Changes and Cardiovascular and Renal Outcomes in Type 1 Diabetes: The DCCT\/EDIC Study"],"prefix":"10.2215","volume":"11","author":[{"given":"Ian H.","family":"de Boer","sequence":"first","affiliation":[{"name":"Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Gao","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Rockville, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Cleary","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Rockville, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionut","family":"Bebu","sequence":"additional","affiliation":[{"name":"Biostatistics Center, The George Washington University, Rockville, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Lachin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Molitch","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism & Molecular Medicine, Northwestern University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Orchard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Paterson","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, Hospital for Sick Children, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce A.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, University of Toronto and University Health Network, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Steffes","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Zinman","sequence":"additional","affiliation":[{"name":"Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications (DCCT\/EDIC) Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,10,24]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(12)61350-6","article-title":"Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: A meta-analysis.","volume":"380","author":"Fox","year":"2012","journal-title":"Lancet"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1056\/NEJMoa021835","article-title":"Regression of microalbuminuria in type 1 diabetes.","volume":"348","author":"Perkins","year":"2003","journal-title":"N Engl J Med"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1681\/ASN.2013091004","article-title":"Renal outcomes in patients with type 1 diabetes and macroalbuminuria.","volume":"25","author":"de 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