An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study

Wu, Akira; Kong, Norella; León, Fiorella; Pan, Changyu; Tai, Tong Yuan; Yeung, Vincent; Yoo, Soon Jib; Rouillon, A.; Weir, Matthew R.

doi:10.1007/s00125-004-1599-9

Cited by 213 publications

(184 citation statements)

References 30 publications

(24 reference statements)

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“…In a recent meta-analysis, Asians were found to have a lower risk of developing cardiovascular disease but a higher risk of renal disease than Caucasians [22,23]. In the present analysis, patients with chronic HBV infection were younger, had earlier onset of disease and were more likely to be insulin-treated and have retinopathy at baseline.…”

Section: Discussionmentioning

confidence: 47%

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

et al. 2006

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Aims/hypothesis: We examined the association between chronic hepatitis B virus (HBV) infection and clinical outcomes in a consecutive cohort of Chinese patients with type 2 diabetes. Subjects, materials and methods: Between 1995 and 1999, 2,838 type 2 diabetes patients underwent comprehensive assessments and blood screening for hepatitis B surface antigen (HBsAg). The risk of occurrence of cardiovascular events and end-stage renal disease (defined as need for dialysis, doubling of serum creatinine or serum creatinine ≥500 μmol/l) was compared between HBsAg-positive and HBsAg-negative groups. Results: At baseline, HBV-infected patients (n=286, 10.1%) were younger (51.0±11.5 vs 53.7±12.7 years, p=0.004), had earlier onset of diabetes (51.0±11.5 vs 53.7±12.7 years, p=0.001) and a higher frequency of retinopathy (28 vs 22%, p=0.03) than non-HBV-infected patients. After a median follow-up of 3.5 years (interquartile range: 1.7-5.9 years) and adjustment of age, glycaemic control and other potential confounding factors, HBV-infected patients were more likely to develop end-stage renal disease than non-HBV infected patients (8.7 vs 6.4%) with a hazard ratio of 4.5 (95% CI 1.1-18.6). The difference in the frequency of cardiovascular endpoints was not statistically significant. Conclusions: In Chinese type 2 diabetes patients, chronic HBV infection was associated with increased risk of end-stage renal disease, and this was independent of other potential confounding factors. Early identification of HBV status and close surveillance of renal function are important in patients with type 2 diabetes who are living in areas where HBV is endemic or who are at risk of chronic HBV infection.

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Section: Discussionmentioning

confidence: 47%

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

et al. 2006

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“…Thus, the prevalence of microalbuminuria may be over-estimated if a random morning urine sample is used. In their paper, Wu et al [1] do not state the proportion of urine samples that were random morning samples, but I speculate that it could have been the majority given the cross-sectional nature of the study. It is my opinion that, in view of the abovementioned limitations, the high prevalence of microalbu-…”

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confidence: 98%

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To the Editor: Wu et al [1] studied the prevalence of albuminuria in 5,549 Asian type 2 diabetic patients. The reported prevalence of microalbuminuria in this group, 39.8%, is remarkably high; higher than the prevalence reported in other populations [2].

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confidence: 99%

“…If this false-positive rate is applied to the study of Wu et al, the prevalence of microalbuminuria is reduced from 39.8 to 29.1%. In the Discussion section of their paper, the authors state that a within-trial validation of the Micral test was performed [1]. The results of the test were compared with those of an immunochemical assay (DCA 2000+commercial kit; Bayer Diagnostics, Germany) in 119 patients and with those of an immunoturbidimetric assay (Beckman Array 360 system; USA) in 56 patients (unfortunately, this sample size is inadequate to give a valid result).…”

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–to: Wu AYT, Kong NCT, de Leon FA, Pan CY, Tai TY, Yeung VTF, Yoo SJ, Rouillon A, Weir MR, for the MAPS investigators (2005) An alarming high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 48: 17–26

Rattarasarn

2005

Diabetologia

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To the Editor: Wu et al. [1] studied the prevalence of albuminuria in 5,549 Asian type 2 diabetic patients. The reported prevalence of microalbuminuria in this group, 39.8%, is remarkably high; higher than the prevalence reported in other populations [2]. However, it should be noted that the method used to identify microalbuminuria in this study was a semi-quantitative test (Micral test; Roche Diagnostics, Mannheim, Germany), which is considered a screening, but not a diagnostic, test for microalbuminuria. We speculate that, in the study of Wu et al., the prevalence of microalbuminuria in Asian type 2 diabetes was over-estimated given high false-positive rate of the Micral test.At this centre, we compared the diagnostic accuracy of the Micral test with that of the standard RIA in 196 diabetic patients [3]. The Micral test showed a high sensitivity (98.9%) and a high negative predictive value (98.6%); however the specificity (68.6%) and the positive predictive value (73.2%) of the test were not as good. Thirty-three of the 105 patients who were negative for microalbuminuria (urine albumin concentration <20 mg/l) according to the RIA were positive according to the Micral test. If this false-positive rate is applied to the study of Wu et al., the prevalence of microalbuminuria is reduced from 39.8 to 29.1%. In the Discussion section of their paper, the authors state that a within-trial validation of the Micral test was performed [1]. The results of the test were compared with those of an immunochemical assay (DCA 2000+commercial kit; Bayer Diagnostics, Germany) in 119 patients and with those of an immunoturbidimetric assay (Beckman Array 360 system; USA) in 56 patients (unfortunately, this sample size is inadequate to give a valid result). The sensitivity and the specificity of the Micral test were 91.9 and 63.4%, respectively, as compared with the DCA 2000+ commercial kit (values close to our results), and 95 and 80%, respectively, as compared with the immunoturbidimetric assay. At best, the positive predictive value of the Micral test would be 82.6%, which would result in the reduction of the prevalence of microalbuminuria to 32.9%.Furthermore, the timing of urine collection may also affect the test result. At this centre, we performed a study that was designed to compare the value of first morning and random morning (void at outpatient clinic visit) urine samples for the determination of microalbuminuria in type 2 diabetic patients. Using the 24-h AER as a reference, it was demonstrated that the cut-off point for microalbuminuria (based on receiver operating characteristic curve analysis) is higher in random morning samples than in first morning samples, regardless of whether this is expressed in terms of albumin concentration or the albumin : creatinine ratio [4]. In agreement with the recommendations of the American Diabetes Association, the cut-off point for microalbuminuria in the first morning sample was 18.7 mg/l or 27.4 mg/g creatinine. However, in the random morning sample, the cut-off point was 34.1 mg/...

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“…APCSC also showed an association between diabetes and increased risk of death as a result of renal disease, cancer, respiratory infections, and other infective and inflammatory causes 21 . Although optimal blood glucose control has been shown to reduce the risk of both macrovascular and microvascular complications 6 , the marked prevalence of renal dysfunction in Asia reflects, in part, the continuing challenge in achieving this goal 22 . The aim of the present article was to review the barriers to achieving optimal blood glucose control in Asian patients with type 2 diabetes who have declining renal function and to discuss the treatment modalities that might be appropriate for the management of these special patient populations.…”

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confidence: 99%

Challenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast Asia perspective

Chow

Chan

Hwu

et al. 2012

J of Diabetes Invest

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It is well recognised that Asia is at the epicenter of the global type 2 diabetes epidemic. Driven by socioeconomic changes involving industrialization, urbanization and adoption of Western lifestyles, the unprecedented increases in the prevalence of diabetes are particularly evident in Southeast Asia. The impact of diabetes is immense, and despite evidence of the benefit of optimal glucose control in reducing the risk of disease progression and development of macrovascular and microvascular complications, many individuals in this region remain poorly controlled. Chronic kidney disease (CKD) is an increasingly common diabetes-associated complication in Asian patients. Furthermore, Southeast Asia has one of the highest rates of end-stage renal disease (ESRD) in the world. Consequently, CKD in diabetes is associated with considerable morbidity and cardiovascular-related mortality, highlighting the need to screen and assess patients early in the course of the disease. The management of type 2 diabetes patients with declining renal function represents a significant challenge. Many of the older antidiabetic agents, such as metformin and sulfonylureas, are limited in their utility in CKD as a result of contraindications or hypoglycemic episodes. In contrast, dipeptidyl-peptidase IV inhibitors have provided a welcome addition to the therapeutic armamentarium for achieving glycemic control in these special populations. With comparable efficacy to and more favorable pharmacokinetic and side-effect profiles than traditional therapies, agents in this drug class, such as linagliptin, offer a more tailored approach to disease control in type 2 diabetes patients with declining renal function. (J Diabetes Invest

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An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study

Cited by 213 publications

References 30 publications

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

–to: Wu AYT, Kong NCT, de Leon FA, Pan CY, Tai TY, Yeung VTF, Yoo SJ, Rouillon A, Weir MR, for the MAPS investigators (2005) An alarming high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 48: 17–26

Challenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast Asia perspective

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