American Journal of Epidemiology Vol. 145, No. 2: 91-102
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factors for Kidney Damage in the Adult Population of Wadena, Minnesota
A Prospective Study
1Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, School of Medicine, University of Minnesota Minneapolis, MN
2Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis, MN
3Division of Nephrology, Department of Pediatrics, School of Medicine, University of Minnesota Minneapolis, MN
4Wadena Medical Center Wadena, MN
Reprint requests to Dr. Frederick Goetz, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454.
An increased albumin excretion rate (AER) is associated with impaired glucose tolerance and diabetes mellitus in some populations, but data on Americans of Northern European origin are lacking. In 1986–1987, AER and creatinine clearance were measured in 455 adults in a survey of the population of Wadena, Minnesota. Thirty-five subjects (8%) had an AER 
15 µg/minute, and eight of these had overt proteinuria (AER 175 µg/minute). AER and creatinine clearance were uncorrelated except when AER was increased. Unadjusted mean AER in a stratified random sample of adults (n = 374) was 3.6 µg/minute. Adjusted values for 277 subjects with normal glucose tolerance and for 80 subjects with impaired glucose tolerance were very similar (3.8 and 3.7 µg/minute, respectively), whereas mean AER was 5.4 µg/minute for persons with non-insulin-dependent diabetes mellitus (NIDDM) who were not taking insulin and 9.4 µg/minute for persons with NIDDM who were taking insulin (p < 0.0001). After adjustment for age, mean creatinine clearance was unrelated to glucose tolerance. Systolic blood pressure was a major determinant of increased AER (p < 0.0001) and lowered creatinine clearance (p = 0.0011), independently of diabetes. AER was stable over 5 years among the 321 cases who were not taking insulin and were not severely hypertensive. The decrease in creatinine clearance was greater in ex-smokers and current smokers than in nonsmokers. The authors conclude that hypertension and NIDDM were independently associated with the risk of kidney damage in this population, as indicated by a higher AER. High-normal blood pressure, but not impaired glucose tolerance, was associated with microalbuminuria. These relatively mild changes may reflect an ethnically based resistance to the damaging effects of hyperglycemia on the kidney. Smoking may accelerate the aging-related decline in glomerular filtration rate. Am J Epidemiol 1997; 145: 91–102.
albuminuria; Caucasoid race; creatinine clearance; diabetes mellitus, insulin-dependent; diabetes mellitus, non-insulin-dependent; glucose intolerance; glycosuria; kidney
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