Increased urinary albumin excretion and its associations in the WHO Multinational Study of Vascular Disease in Diabetes

Bennett, P. H.; Lee, E. T.; Lu, Mengji; Keen, H.; Fuller, J. H.

doi:10.1007/pl00002938

Cited by 35 publications

(31 citation statements)

References 14 publications

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“…The high renal failure rate in American Indians has been reported previously and is consistent with the higher incidence of renal failure in this group [4]. Our analysis shows that plasma glucose appears to be the most important determinant of this increased risk and suggest that triglycerides could also be involved (Table 4).…”

Section: Discussionsupporting

confidence: 91%

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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: 91%

“…With over 43 670 person years of follow-up it is in a unique position to provide information on risk factors for renal failure. Another paper in this supplement focuses on risk factors for and prevalence of albuminuria, an early marker of renal failure, for which only prevalence data rather than incidence data were available [4].…”

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

et al. 2001

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“…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.…”

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confidence: 56%

–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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“…revious studies have reported a marked variation in the prevalence of microalbuminuria in type 2 diabetic patients ranging from 7 to 47% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The variation could arise from ethnic/genetic differences in susceptibility (3)(4)(5)(6)(7)(8)(9)(10)(11) and from methodological issues for investigating the prevalence, such as small-sized populations (3,12,13); single clinic-based studies (8,12); use of the dipstick method instead of quantitative determinations (4,5); or only a single measurement of urinary albumin excretion (UAE) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), whereas multiple measurements have been recommended for years (14).…”

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Microalbuminuria Is Common in Japanese Type 2 Diabetic Patients

2007

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Increased urinary albumin excretion and its associations in the WHO Multinational Study of Vascular Disease in Diabetes

Abstract: Centres varied widely in the prevalence of increased albumin excretion but associations with risk factors and vascular complications were generally similar in most centres and in both major types of diabetes with ethnic and genetic differences probably contributing.

Cited by 35 publications

References 14 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

–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

Microalbuminuria Is Common in Japanese Type 2 Diabetic Patients

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