(HealthDay News) — Among US adults with diabetes, albumin-to-creatinine ratio (ACR) values are decreasing, but mortality rates are increasing among those with ACR <30 mg/g and low estimated glomerular filtration rates (eGFRs), according to a study published online in Diabetes Care.

Holly Kramer, MD, MPH, from Loyola University Chicago, and colleagues used data from the National Health and Nutrition Examination Surveys 1988 to 2006 to examine mortality trends in adults with diabetes. Via linkage with the National Death Index, mortality trends were examined by chronic kidney disease phenotype (eGFR and urine ACR level).

The researchers found that from 1988 to 2006, there was an increase in adults with an eGFR <60 mL/min/1.73 m² and an ACR <30 mg/g, from ~0.9 million (6.6% of the total population with diabetes during 1988 to 1994) to 2.4 million (10.1% of the total population with diabetes during 2007 to 2010). There was a general downward trend in mortality rates for adults with diabetes and an ACR ≥30 mg/g, but an increase was seen among those with an eGFR <60 mL/min/1.73 m² and an ACR <30mg/g, from 35 to 51 deaths per 1000 persons years during 1988-1994 to 2003-2006.

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“ACR values are decreasing in US adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR <30 mg/g,” the authors write.

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Kramer H, Boucher RE, Leehey D, et al. Increasing Mortality in Adults With Diabetes and Low Estimated Glomerular Filtration Rate in the Absence of Albuminuria. Diab Care 2018 Feb; dc171954. doi:10.2337/dc17-1954