A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Xu, Jiaqiong; Lee, Elisa T.; Devereux, Richard B.; Umans, Jason G.; Bella, Jonathan N.; Shara, Nawar M.; Yeh, Jeunliang; Fabsitz, Richard R.; Howard, Barbara V.

doi:10.1053/j.ajkd.2007.11.010

« Previous Next »American Journal of Kidney Diseases
Volume 51, Issue 3 , Pages 415-424, March 2008

A Longitudinal Study of Risk Factors for Incident Albuminuria in Diabetic American Indians: The Strong Heart Study

Jiaqiong Xu, PhD
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK
- Address correspondence to Jiaqiong Xu, PhD, Center for Biostatistics, The Methodist Hospital Research Institute, 6565 Fannin St MGJ6, Houston, TX 73030.
Elisa T. Lee, PhD
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Richard B. Devereux, MD
- Weill Cornell Medical College, New York, NY
Jason G. Umans, MD, PhD
- MedStar Research Institute, Hyattsville, MD
Jonathan N. Bella, MD
- Bronx-Lebanon Hospital Center and Albert Einstein College of Medicine, Bronx, NY
Nawar M. Shara, PhD
- MedStar Research Institute, Hyattsville, MD
Jeunliang Yeh, PhD
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Richard R. Fabsitz, PhD
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
Barbara V. Howard, PhD
- MedStar Research Institute, Hyattsville, MD

Received 5 June 2007; accepted 14 November 2007. published online 28 January 2008.

Background

There have been no studies that use longitudinal data with more than 2 measurements and methods of longitudinal data analysis to identify risk factors for incident albuminuria over time more effectively.

Study Design

Longitudinal study.

Settings & Participants

A subgroup of participants in the Strong Heart Study, a population-based sample of American Indians, in central Arizona, Oklahoma, and North and South Dakota. Participants with diabetes without albuminuria were followed up for a mean of 4 years.

Predictors

Age, sex, study center, high-density lipoprotein and low-density lipoprotein cholesterol levels, triglyceride level, body mass index, systolic blood pressure, use of antihypertensive medication, smoking, hemoglobin A_1c level, fasting glucose level, type of diabetes therapy, diabetes duration, plasma creatinine level, and urinary albumin-creatinine ratio (UACR).

Outcomes & Measurements

Albuminuria was defined as UACR of 30 mg/g or greater. Urine creatinine and albumin were measured by using the picric acid method and a sensitive nephelometric technique, respectively.

Results

Of 750 and 568 participants with diabetes without albuminuria and with normal plasma creatinine levels at the first and second examinations, 246 and 132 developed albuminuria by the second and third examinations, respectively. Incident albuminuria was predicted by baseline UACR, fasting glucose level, systolic blood pressure, plasma creatinine level, study center, current smoking, and use of angiotensin-converting enzyme inhibitors and antidiabetic medications. UACR of 10 to 30 mg/g increased the odds of developing albuminuria 2.7-fold compared with UACR less than 5 mg/g.

Limitations

Single random morning urine specimen.

Conclusions

Many risk factors identified for incident albuminuria can be modified. Control of blood pressure and glucose level, smoking cessation, and use of angiotensin-converting enzyme inhibitors may reduce the incidence of albuminuria.

Index Words: Longitudinal analysis, risk factors, incidence, albuminuria, American Indians