A Prospective Population-Based Study of Microalbuminuria as a Predictor of Mortality in NIDDM

Neil, Andrew; Hawkins, Michael M.; Potok, M H N; Thorogood, Margaret; Cohen, David; Mann, Jim

doi:10.2337/diacare.16.7.996

Cited by 216 publications

(149 citation statements)

References 23 publications

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“…These data confirm the well-recognised importance of proteinuria as a predictor of renal failure in both Type I [9±12] and Type II diabetes [13,14]. Light proteinuria was associated with a threefold increased risk of renal failure in patients with Type I diabetes and a twofold increase among those with Type II diabetes, adjusted for age.…”

Section: Discussionsupporting

confidence: 85%

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

et al. 2001

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Diabetes accounts for one third or more of all new end stage renal disease in the United States and accounts for at least 16 % of all new patients going onto renal replacement therapy in Europe [1]. The most common cause of end stage renal disease in diabetes is diabetic glomerulosclerosis (nephropathy).Previous studies have shown that hyperglycaemia is an important risk factor for diabetic renal disease [2,3]. More controversy exists on the extent to which systolic blood pressure and lipid disturbances are risk factors for renal disease rather than being a consequence of it. Data on risk factors for renal disease in prospective studies of diabetes are sparse. The Diabetologia (2001) Results. In 959 subjects with Type I (insulin-dependent) diabetes mellitus and 2559 with Type II (noninsulin-dependent) diabetes mellitus, the average follow-up was 8.4 years ( 2.7). By the end of the follow-up period 53 patients in the Type I diabetic group and 134 patients in the Type II diabetic group had developed renal failure (incidence rate 6.3:1000 person years). Increasing age and duration of diabetes were associated with renal failure in Type II and Type I diabetes. In Type II diabetes duration of diabetes was a more important risk factor than age. In both Type I and Type II diabetic retinopathy and proteinuria were strongly associated with renal failure. Systolic blood pressure was associated with renal failure in Type I but not in Type II diabetic patients. ECG abnormalities at baseline, self-reported smoking and cholesterol were not associated with renal failure. Triglycerides were measured in a subset of centres. Among those with Type II, but not Type I diabetes, triglycerides were associated with renal failure independently of systolic blood pressure, proteinuria or retinopathy. In Type II diabetes fasting plasma glucose was associated with renal failure independently of other risk factors. Conclusion/interpretation. We have confirmed the role of proteinuria and retinopathy as markers of renal failure and the importance of hyperglycaemia in renal failure in Type I and Type II diabetes. Plasma triglycerides seem to be an important predictor of renal failure in Type II diabetes. In Type I diabetes systolic blood pressure is an important predictor of renal failure. [Diabetologia (2001)

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Section: Discussionsupporting

confidence: 85%

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

et al. 2001

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“…It is considered to be an early indicator of renal and cardiovascular disease risk, 2,3 as well as of an increased risk of all-cause mortality. 4,5 Thus, microalbuminuria is an indication for aggressive intervention to improve glycaemic and blood pressure (BP) control and to reduce cardiovascular risk factors.…”

Section: Introductionmentioning

confidence: 99%

Rosiglitazone reduces urinary albumin excretion in type II diabetes

et al. 2003

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This study examines the effect of rosiglitazone on urinary albumin excretion (UAE) in patients with type II diabetes. Urinary albumin : creatinine ratio (ACR) was measured in a 52-week, open-label, cardiac safety study comparing rosiglitazone and glyburide. Patients were randomised to treatment with rosiglitazone 4 mg b.i.d. or glyburide. ACR was measured at baseline and after 28 and 52 weeks of treatment. Statistically significant reductions from baseline in ACR were observed in both treatment groups at week 28. By week 52, only the rosiglitazone group showed a significant reduction from baseline. Similar results were observed for the overall study population and for the subset of patients with baseline microalbuminuria. For patients with microalbuminuria at baseline, reductions in ACR did not correlate strongly with reductions in glycosylated haemoglobin, or fasting plasma glucose, but showed strong correlation with changes in mean 24-h systolic and diastolic blood pressure for rosiglitazone-treated patients (DACR vs Dmean 24-h systolic blood pressure, r ¼ 0.875; DACR vs Dmean 24-h diastolic blood pressure, r ¼ 0.755; Po0.05 for both). No such correlation was observed for glyburide-treated patients. In conclusion, rosiglitazone treatment was associated with a decrease in urinary albumin excretion. These findings suggest a potential beneficial effect of rosiglitazone in the treatment or prevention of renal and vascular complications of type II diabetes.

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“…The presence of micro-and macroalbuminuria predict all-cause mortality [19,[21][22][23][24], and microalbuminuria is an independent predictor of cardiovascular mortality in patients with diabetes [22,23,25]. At a lower cut-off value, urinary albumin was predictive of the development of ischemic heart disease [26] as well as cardiovascular mortality in the general population [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…However, in many epidemiological studies of microalbuminuria this variable is classified as a categorical variable [21,22,35,36].…”

Section: Discussionmentioning

confidence: 99%

Orosomucoid in urine is a powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes at five years of follow-up

et al. 2005

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Aims/hypothesis: To study whether urinary orosomucoid excretion rate (UOER) predicts mortality in normoalbuminuric patients with diabetes at 5 years of follow-up, and to investigate the relationship between orosomucoid in serum and urine. Methods: A cohort of 578 patients with diabetes (430 type 2, 148 type 1) was followed prospectively for an average of 5 years. UOER was measured in timed overnight urine samples. Results: Eightytwo patients with type 2 diabetes and 17 patients with type 1 diabetes died. Among patients with type 2 diabetes, 251 (58%) had normoalbuminuria; increased UOER independently predicted cardiovascular mortality (OR 4.94, 95% CI 1.60−15.22; p<0.006) in those with normoalbuminuria and in the entire cohort of patients with type 2 diabetes (odds ratio 3.63, 95% CI 1.50−8.81; p<0.005). Patients with increased UOER had a higher all-cause mortality than those with normal UOER (log-rank test, p<0.001 for type 2 patients; p<0.04 for type 1 patients). In patients with type 1 diabetes, there were five cardiovascular deaths and no significant predictive value of UOER. Patients with increased UOER had a subclinical increase in serum orosomucoid. Conclusion/interpretation: Increased UOER was an independent, powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes and in the entire cohort of patients with type 2 diabetes. There were indications of UOER as being a valuable marker in type 1 diabetes that showed differences in survival between patients with normal versus increased UOER. Serum orosomucoid was associated with UOER; UOER may be a marker of lowgrade inflammation in patients with diabetes.

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A Prospective Population-Based Study of Microalbuminuria as a Predictor of Mortality in NIDDM

Cited by 216 publications

References 23 publications

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

Risk factors for renal failure: The WHO multinational study of vascular disease in diabetes

Rosiglitazone reduces urinary albumin excretion in type II diabetes

Orosomucoid in urine is a powerful predictor of cardiovascular mortality in normoalbuminuric patients with type 2 diabetes at five years of follow-up

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