Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton, Giuseppe; Cordiano, Rocco; Palmieri, Rosa; Toni, Renzo De; Guarnieri, Gianluigi; Palatini, Paolo

doi:10.1007/s00125-004-1486-4

Cited by 18 publications

(8 citation statements)

References 33 publications

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“…In addition, albuminuria has been reported to be an independent risk factor for cardiovascular morbidity and mortality (12)(13)(14). The present study showed that a reduction of microalbuminuria is associated with a lower risk for cardiovascular and renal events.…”

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confidence: 63%

Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

et al. 2007

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OBJECTIVE-Microalbuminuria in diabetic patients is a predictor for diabetic nephropathy and cardiovascular disease. The aim of this study is to investigate the clinical impact of reducing microalbuminuria in type 2 diabetic patients in an observational follow-up study.RESEARCH DESIGN AND METHODS-We enrolled 216 type 2 diabetic patients with microalbuminuria during an initial 2-year evaluation period and observed them for the next 8 years. Remission and a 50% reduction of microalbuminuria were defined as a shift to normoalbuminuria and a reduction Ͻ50% from the initial level of microalbuminuria. The association between reducing microalbuminuria and first occurrence of a renal or cardiovascular event and annual decline rate of estimated glomerular filtration rate (eGFR) was evaluated.RESULTS-Twelve events occurred in 93 patients who attained a 50% reduction of microalbuminuria during the follow-up versus 35 events in 123 patients without a 50% reduction. The cumulative incidence rate of events was significantly lower in patients with a 50% reduction. A pooled logistic regression analysis revealed that the adjusted risk for events in subjects after a 50% reduction was 0.41 (95% CI 0.15-0.96). In addition, the annual decline rate of eGFR in patients with a 50% reduction was significantly slower than in those without such a reduction. The same results were also found in the analysis regarding whether remission occurred.CONCLUSIONS-The present study provides clinical evidence implying that a reduction of microalbuminuria in type 2 diabetic patients is an integrated indicator for renal and cardiovascular risk reduction.

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confidence: 63%

Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

et al. 2007

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] It is also associated with increased risk of death in patients with myocardial infarction. 16,17 Essential hypertension and microalbuminuria in nondiabetic individuals was first associated in 1974 18 and later confirmed in subsequent studies. 1,10,19 -21 Measurement of microalbuminuria is in some guidelines recommended for risk stratification in people with hypertension.…”

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confidence: 66%

New Definition of Microalbuminuria in Hypertensive Subjects

et al. 2005

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Abstract-Microalbuminuria has so far been defined as urinary albumin excretion between 20 and 200 g/min (or 15 to 150 g/min overnight). In a recent report, an overnight urinary albumin excretion Ͼ5 g/min was strongly predictive of coronary heart disease and death in the general population. The aim of the present study was to confirm this observation in a population of hypertensive individuals. In The Third Copenhagen City Heart Study in 1992 to 1994, 1734 men and women aged 30 to 70 years with hypertension, but no history of coronary heat disease, delivered a timed overnight urine sample. They were followed-up prospectively by registers until 2000 with respect to coronary heart disease, and until 2004 with respect to death. During follow-up, 123 incident cases of coronary heart disease and 308 deaths were traced. Incident coronary heart disease occurred in 11% of subjects with urinary albumin excretion Ն5 g/min compared with 5% in subjects with urinary albumin excretion Ͻ5 g/min (PϽ0.001). Similarly, the cumulative mortality was 28% versus 13% (PϽ0.001). The relative risks of coronary heart disease and death associated with urinary albumin excretion Ն5 g/min were 2.0 (1.4 to 2.9; PϽ0.001) and 1.9 (1.5 to 2.3; PϽ0.001), respectively, after adjustment for age, sex, blood pressure level, antihypertensive drugs, diabetes, creatinine clearance, smoking, lipoproteins, and body mass index. In conclusion, our study supports the new definition of microalbuminuria as urinary albumin excretion Ͼ5 g/min. In future risk assessment in hypertensive individuals, measurement of microalbuminuria has to be included.

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“…Numerous studies in diabetic individuals with microalbuminuria demonstrate higher morbidity and mortality from cardiovascular disease (2-6). Microalbuminuria in diabetic subjects strongly predicts cardiovascular mortality even in the setting of acute myocardial infarction (24). This evidence suggests that remission/regression of microalbuminuria results in reduction of risk from cardiovascular disease.…”

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confidence: 90%

Factors Associated With Frequent Remission of Microalbuminuria in Patients With Type 2 Diabetes

Araki

Haneda²,

Sugimoto³

et al. 2005

Diabetes

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To estimate the frequency of remission/regression of microalbuminuria and to identify factors affecting such outcomes in Japanese patients with type 2 diabetes, we observed 216 patients with type 2 diabetes and microalbuminuria enrolled during an initial 2-year evaluation period for the next 6 years. Remission was defined as shift to normoalbuminuria and regression as a 50% reduction in urinary albumin excretion rate (AER) from one 2-year period to the next. Reduction of urinary AER was frequent, with a 6-year cumulative incidence of 51% (95% CI 42-60) for remission and 54% (45-63) for regression, whereas the frequency of progression to overt proteinuria was 28% (19 -37). Microalbuminuria of short duration, the use of renin-angiotensin system-blocking drugs, and lower tertiles for HbA 1c (<6.95%) and systolic blood pressure (<129 mmHg) were independently associated with remission or regression in the pooled logistic regression analysis. The results indicate that reduction in urinary AER occurs frequently in Japanese patients with type 2 diabetes. Early detection of microalbuminuria and a multifactorial control may result in improved outcomes for diabetic nephropathy and cardiovascular events. Diabetes 54: 2983-2987, 2005 D iabetic nephropathy is a serious complication of diabetes and a leading cause of end-stage renal disease (ESRD). The earliest clinical sign of diabetic nephropathy is an elevated urinary albumin excretion, referred to as microalbuminuria. Microalbuminuria is defined as an albumin excretion rate (AER) of 20 -199 g/min in a timed or a 24-h urine collection (equivalent to 30 -299 mg/g creatinine in a random spot sample) (1). Microalbuminuria in diabetic patients has been recognized not only as a predictor of progression of diabetic nephropathy but also as a powerful independent risk factor for cardiovascular disease (2-7). Thus, the prevention of elevated urinary albumin excretion is an important therapeutic target for the prevention of renal and cardiovascular events, and it continues to be important to explore modifiable factors that affect microalbuminuria.Recently, the concept of remission or regression of microalbuminuria has been proposed as an outcome. Intervention studies with ACE inhibitors or angiotensin II type 1 receptor blockers (ARBs) in subjects with type 2 diabetes have shown that reduction of microalbuminuria can be induced (8 -10). Also, Perkins et al. (11) from the Joslin Diabetes Center have reported that regression of microalbuminuria in type 1 diabetes occurred more frequently than progression to persistent proteinuria.In the present study, we estimated the frequencies of remission and regression of microalbuminuria in Japanese patients with type 2 diabetes and identified the factors affecting these outcomes. In addition, we evaluated whether clinical practice guidelines were adequate to induce remission and regression of microalbuminuria. RESEARCH DESIGN AND METHODSThe subjects were recruited from among the participants in the Shiga Prospective Observational Follow-Up Study...

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Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Cited by 18 publications

References 33 publications

Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

Reduction in Microalbuminuria as an Integrated Indicator for Renal and Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

New Definition of Microalbuminuria in Hypertensive Subjects

Factors Associated With Frequent Remission of Microalbuminuria in Patients With Type 2 Diabetes

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