Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study

Abstract

Methods. Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU. Results. Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30-299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c <7% and waist circumference ≤102 cm showed the lowest prevalence of MAU (7.5%), and represented the reference class. Patients with retinopathy, waist circumference >98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8-27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU. Conclusions. The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors.

Increased Prevalence of Albuminuria in HIV-Infected Adults with Diabetes

“…The prevalence of albuminuria among the HIV-infected subjects without diabetes was similar to the 11% identified by Szczech and colleagues in a similar HIV-infected cohort [13]. The prevalence of albuminuria noted among the uninfected controls with diabetes was slightly lower than other large diabetes cohort studies [14], [16], but the duration of diabetes in our study population was relatively short by comparison and may account for this difference. We did not identify an increased prevalence of albuminuria related to African American race or Hispanic ethnicity as seen in prior large US population surveys [17].…”

Rapid Rise in Hypertension and Nephropathy in Youth With Type 2 Diabetes

“…A recent comprehensive review of adult randomized controlled trials between 1960 and 2012 reporting major cardiovascular or renal outcomes reinforced the importance of renin-angiotensin system blocker therapy in patients with type 2 diabetes who have an enhanced risk for cardiovascular disease (30). Similar reports regarding early hypertension and renal comorbidities associated with type 2 diabetes in youth are limited (9,11,26). …”

Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy

“…Recent epidemiological studies suggest that visceral obesity is also associated with increased risk of incident chronic kidney disease (CKD) [7,8]. We and others have previously demonstrated that increased waist circumference, an essential component of the metabolic syndrome, is closely and independently associated with microalbuminuria in patients with type 2 diabetes [5,9]. In addition, two large cohort studies of type 1 and type 2 diabetes clarified that increased waist circumference was significantly associated with incident microalbuminuria [10,11].…”

“…Microalbuminuria is a sensitive and potent prognostic marker to evaluate not only the risk of overt nephropathy but increased cardiovascular disease in patients with diabetes [1]; however, its pathogenesis is largely unknown and likely multifactorial [2][3][4][5]. Obesity, especially visceral obesity, has long been recognized as a risk factor for cardiovascular diseases [6].…”