Microalbuminuria: A Major Risk Factor in Non‐insulin‐dependent Diabetes. A 10‐year Follow‐up Study of 503 Patients

Abstract

The impact of microalbuminuria on mortality as well as other risk factors was investigated in a 10-year follow-up study of 503 predominantly non-insulin-dependent diabetic patients of whom 265 had died. Using Cox's regression analysis the prognostic influence of age, sex, age at diagnosis, known diabetes duration, blood pressure, fasting plasma glucose, relative weight, serum creatinine, retinopathy, and treatment was evaluated as well as morning urine albumin concentration (UAC) in four categories, i.e. UAC less than or equal to 15 micrograms/ml (normal), 15 micrograms/ml less than UAC less than or equal to 40 micrograms/ml, 40 micrograms/ml less than UAC less than or equal to 200 micrograms/ml and UAC greater than 200 micrograms/ml. Age, UAC, known duration, and serum creatinine were the only significant risk factors. After correction for the other three independent risk factors, the hazard ratios in the elevated UAC categories relative to the group with UAC less than or equal to 15 micrograms/ml were 1.53 (p = 0.007), 2.28 (p = 0.000002), and 1.82 (p = 0.02). The statistically significant correlations with UAC were: age (r = 0.09, p less than 0.05), duration (r = 0.14, p less than 0.01), systolic blood pressure (r = 0.12, p less than 0.01), serum creatinine (r = 0.33, p less than 0.001), and fasting plasma glucose (r = 0.12, p less than 0.01). Increased UAC was associated also with retinopathy (p = 0.01). Fifty-eight per cent of the deaths were caused by cardiovascular disease or stroke; only 3% died from uraemia. A reinvestigation including blood pressure, fasting plasma glucose, and UAC was made on 208 survivors.

Proteinuria and metabolic syndrome as predictors of cardiovascular death in non-diabetic and type 2 diabetic men and women

“…Our finding that proteinuria alone predicted CVD is also in accord with findings from other studies [1][2][3][4][5][6][7][8][9][10][11][12]. Microalbuminuria has been shown to be related to insulin resistance and hyperinsulinaemia [35][36][37][38][39], and other components of metabolic syndrome, including blood pressure [40,41], high levels of triglycerides and apolipoprotein B [42,43] and obesity [44].…”

“…Microalbuminuria and proteinuria predict cardiovascular disease (CVD) events, not only in diabetic [1][2][3][4][5][6][7], but also in non-diabetic individuals [5,[8][9][10][11][12]. Microalbuminuria was included in the WHO definition of the metabolic syndrome in 1998 [13], but since then there has been debate about microalbuminuria as a component of the metabolic syndrome [14].…”

Diabetic retinopathy

“…DR is found in 85 to 99% of patients with Type I diabetes and persistent proteinuria but only in 47 to 63% of people with Type II diabetes [57,58], suggesting that about 30% of proteinuria in the latter might not be due to diabetic nephropathy. As a clinically relevant consequence, further diagnostic procedures are indicated in confirmed proteinuria if DR is absent, as kidney lesions can have a non-diabetic origin.…”

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

“…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].…”