Aims: The aims of the study were to evaluate the prevalence of increased urinary albumin excretion (UAE) and associated cardiovascular risk factors and vascular diabetes complications in patients with type 2 diabetes mellitus (DM). Methods: We studied 975 patients in a cross-sectional design from 1998 to 2000. Frequency of micro- and macroalbuminuria, and their associations with cardiovascular risk factors and vascular DM complications, were examined. Results: Prevalence of increased UAE was 28.5% (18.3% micro- and 10.2% macroalbuminuria). Body mass index (BMI) (only females) and hemoglobin (Hb)A1c significantly correlated with macroalbuminuria (p = 0.034, p = 0.027, respectively), while high blood pressure (diastolic) was associated with microalbuminuria (p = 0.008). Diabetes duration, high systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides were significantly correlated with both micro- and macroalbuminuria. Increased UAE was associated with neuropathy (relative risk (RR) 2.12, confidence interval (CI) 1.07–4.19), retinopathy (RR 2.19, CI 1.76–2.74) and hypertension (RR 2.91, CI 1.77–4.78), but not with cardiovascular disease, high cholesterol and peripheral vascular disease. In the multiple logistic regression analysis, a significant association of albuminuria was found with diabetes duration (odds ratio (OR) 1.59, CI 0.98–2.58; p < 0062), hypertension (OR 3.42, CI 2.22–5.27; p < 0.0001), low HDL cholesterol (OR 1.78, CI 1.31–2.43; p < 0.0003), current smoking status (OR 2.19, CI 1.32–3.64; p < 0.0024), and increased serum creatinine (OR 11.16, CI 5.7–21.7; p < 0.0001). Conclusion: Prevalence of increased UAE was similar to that described in other geographically close populations. The stronger association found with microvascular diabetes complications suggests that increased UAE is a better predictor for renal damage than for cardiovascular disease in this type 2 DM population.

Keywords:
Albuminuria, Diabetes mellitus, Diabetes complications, Cardiovascular disease
1.
US Renal Data System: USRDS 2001 Annual Data Report. Atlas of End-Stage Renal Disease in the United States. Bethesda, NIH, National Institute of Diabetes and Digestive and Kidney Diseases, 2001.
2.
Parving HH, Hommel E, Mathiesen E, Skott P, Edsberg B, Bahnsen M, Lauritzen M, Hougaard P, Lauritzen E: Prevalence of microalbuminuria, arterial hypertension, retinopathy and neuropathy in patients with insulin-dependent diabetes. BMJ 1988;296:156–160.
3.
Orchard TJ, Dorman JS, Maser RE, Becker DJ, Drash AL, Ellis D, LaPorte RE, Kuller LH: Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes 1990;39:1116–1124.
4.
Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM: Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes. N Engl J Med 1989;321:1074–1079.
5.
Ritz E, Stefanski A: Diabetic nephropathy in type II diabetes. Am J Kidney Dis 1996;27:167–194.
6.
Ritz E: Nephropathy in type 2 diabetes. J Intern Med 1999;245:111–126.
7.
Mogensen CE: Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984;310:356–360.
8.
Klein R, Klein BE, Moss SE, Cruickshanks KJ: Ten-year incidence of gross proteinuria in people with diabetes. Diabetes 1995;44:916–923.
9.
Ismail N, Becker B, Strzelczyk P, Ritz E: Renal disease and hypertension in non-insulin-dependent diabetes mellitus. Kidney Int 1999;55:1–28.
10.
Mattock MB, Morrish NJ, Viberti G, Keen H, Fitzgerald AP, Jackson G: Prospective study of microalbuminuria as predictor of mortality in NIDDM. Diabetes 1992;41:736–741.
11.
Stehouwer CD, Nauta JJ, Zeldenrust GC, Hackeng WH, Donker AJ, den Ottolander GJ: Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet 1992;340:319–323.
12.
UK Prospective Diabetes Study Group: UK Prospective Diabetes Study (UKPDS). X. Urinary albumin excretion over 3 years in diet-treated type 2 (non-insulin-dependent) diabetic patients and association with hypertension, hyperglycaemia, and hypertriglyceridaemia. Diabetologia 1993;36:1021–1029.
13.
Valmadrid CT, Klein R, Moss SE, Klein BE: The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med 2000;160:1093–1100.
14.
Mogensen CE: Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes 1990;39:761–767.
15.
Fioretto P, Steffes MW, Brown DM, Mauer SM: An overview of renal pathology in insulin-dependent diabetes mellitus in relationship to altered glomerular hemodynamics. Am J Kidney Dis 1992;20:549–558.
16.
American Diabetes Association: Clinical practice recommendations 1999. Diabetes Care 1999;22(suppl 1):S66–S69.
17.
Lee ET, Keen H, Bennett PH, Fuller JH, Lu M: Follow-up of the WHO Multinational Study of Vascular Disease in Diabetes: General description and morbidity. Diabetologia 2001;44(suppl 2):S3–S13.
18.
Cabezas-Cerrato J: The prevalence of clinical diabetic polyneuropathy in Spain: A study in primary care and hospital clinic groups. Neuropathy Spanish Study Group of the Spanish Diabetes Society. Diabetologia 1998;41:1263–1269.
19.
Bennett PH, Lee ET, Lu M, Keen H, Fuller JH: Increased urinary albumin excretion and its associations, in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001;44(suppl 2):S37–S45.
20.
Relimpio F, Pumar A, Losada F, Molina J, Maynar A, Acosta D, Astorga R: Urinary albumin excretion rate and cardiovascular disease in Spaniard type 2 diabetic patients. Diabetes Res Clin Pract 1997;36:127–134.
21.
De Pablos PL, Martinez J, Martinez MP, Doreste JA: Prevalence of micro- and macroalbuminuria in a Canadian population of type 2 diabetic patients. Relationship with blood pressure, lipid profile, obesity and metabolic control. Diabetes Metab 1998;24:337–343.
22.
UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–853.
23.
Gall MA, Hougaard P, Borch-Johnsen K, Parving H: Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin-dependent diabetes mellitus: Prospective, observational study. BMJ 1997;15:783–788.
24.
Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R: Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med 1998;11:998–1004.
25.
Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh W, Sowers J: Preserving renal function in adults with hypertension and diabetes: A consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000;36:646–661.
26.
United Kingdom Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703–713.
27.
Parving HH, Gall MA, Skott P, Jorgensen HE, Lokkegaard H, Jorgensen F, Nielsen B, Larsen S: Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients. Kidney Int 1992;41:758–762.
28.
Christensen PK, Larsen S, Horn T, Olsen S, Parving HH: Causes of albuminuria in patients with type 2 diabetes without diabetic retinopathy. Kidney Int 2000;58:1719–1731.
29.
Schwartz MM, Lewis EJ, Leonard-Martin T, Lewis JB, Batlle D: Renal pathology patterns in type II diabetes mellitus: Relationship with retinopathy. Nephrol Dial Transplant 1998;13:2547–2552.
30.
Gall MA, Rossing P, Skott P, Damsbo P, Vaag A, Bech K, Dejgaard A, Lauritzen M, Lauritzen E, Hougaard P, et al: Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1991;34:655–661.
31.
Forsblom CM, Groop PH, Ekstrand A, Totterman KJ, Sane T, Saloranta C, Groop L: Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM. Diabetes Care 1998;21:1932–1938.
32.
Bianchi S, Bigazzi R, Campese VM: Microalbuminuria in essential hypertension: Significance, pathophysiology, and therapeutic implications. Am J Kidney Dis 1999;34:973–995.
33.
Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S; HOPE Study Investigators: Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001;286:421–426.
34.
Wachtell K, Olsen MH, Dahlof B, Devereux RB: Microalbuminuria in hypertensive patients with electrocardiographic left ventricular hypertrophy: The LIFE Study. J Hypertens 2002;20:405–412.
© 2005 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.