Microalbuminuria Predicts Mortality in Noninsulin‐dependent Diabetes

Abstract

Forty-four non-insulin-dependent diabetics (NIDD), all with urine negative to Albustix, were studied in 1966/67. By the end of 1980, 17 had died, all but two from cardiovascular causes. All causes of mortality and time to death were significantly related in univariate analyses to age and to the overnight urinary albumin excretion rate (AER), but not to systolic and diastolic blood pressure levels or to duration of diabetes when the latter was corrected for age. Age and duration were highly correlated with each other. In multivariate analyses age and AER were independent predictors of both mortality and time to death, with AER having the greater degree of significance. Thus subclinically elevated albumin excretion rates ('microalbuminuria') indicate a substantially increased mortality risk in non-insulin-dependent diabetes.

Insulin resistance, hypertension and microalbuminuria in patients with Type 2 (non-insulin-dependent) diabetes mellitus

“…Microalbuminuria has also been considered an independent risk factor for cardiovascular disease [9][10][11]27]. Type 2 diabetic patients with microalbuminuria have elevated levels ofvon Willebrand factor (vWF) as a sign of endothelial dysfunction [24].…”

“…overnight urinary albumin excretion rate (AER) above 20 btg/min predicts overt diabetic nephropathy in both patients with Type 1 (insulin-dependent) [6,7] and Type 2 diabetes [8]. In addition, microalbuminuria is associated with increased cardiovascular mortality in patients with Type 2 diabetes [9,10]. Only a small proportion of this excess cardiovascular mortality in Type 2 diabetes can be explained by end-stage renal failure.…”

Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus

“…Transverse cohort and longitudinal studies have demonstrated that microalbuminuria is a predictor of large vessel disease [3][4][5] . Its prevalence varies in patients with diabetes from 7.6 to 42% [18][19][20] .…”

“…However, it is important to emphasize that glycemic control can influence specific phases of the metabolism of lipids, such as the reverse transport of cholesterol. Recently, it was demonstrated that the glycation of HDL, especially the subfraction HDL 3 , favors a faster and more efficient transfer of cholesterol from this fraction to apoprotein B-containing lipoproteins 41 . We did not observe an association between lipid disorders and CAD, as described in studies with diabetic and nondiabetic patients 39,42,43 .…”

“…Today, it is recognized that the presence of microalbuminuria, in addition to being a marker of incipient renal disease in diabetic patients, seems to be also a marker of large vessel disease, and is associated with an increased cardiovascular disease mortality, especially coronary heart disease [3][4][5] . This increased mortality is due, in part, to a greater prevalence of other risk factors in patients with microalbuminuria, such as lipid disorders, hypertension (H), increased fibrinogen levels and blood rheology changes 6,7 .…”