Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: A global perspective

Abstract

We described the characteristics in a referred cohort of type II diabetic patients in the Developing Education on Microalbuminuria for Awareness of renal and cardiovascular risk in Diabetes study evaluating the global prevalence and determinants of microalbuminuria (MA). A cross-sectional study evaluating 32,208 type II diabetic patients without known albuminuria from 33 countries was performed. Overall, 8057 patients were excluded, either because of prior known proteinuria or non-diabetic nephropathy (3670), or because of invalid urine collections (4387). One single random urinary albumin/creatinine ratio was obtained in 24,151 patients (75%). The overall global prevalence of normo-, micro-, and macroalbuminuria was 51, 39, and 10%, respectively. The Asian and Hispanic patients had the highest prevalence of a raised urinary albumin/creatinine ratio (55%) and Caucasians the lowest (40.6), P<0.0001. HbA1c, systolic blood pressure (BP), ethnicity, retinopathy, duration of diabetes, kidney function, body height, and smoking were all independent risk factors of MA, P<0.0001. Estimated glomerular filtration rate was below 60 ml/min/1.73 m(2) in 22% of the 11,573 patients with available data. Systolic BP below 130 mmHg was found in 33 and 43% had an HbA1c below 7%. The frequency of patients receiving aspirin was 32%, statins 29%, and BP-lowering therapy 63%. A high prevalence globally of MA and reduced kidney function, both conditions associated with enhanced renal and cardiovascular risk, was detected in type II diabetic patients without prior known nephropathy. Early detection, monitoring of vascular complications, and more aggressive multifactorial treatment aiming at renal and vascular protection are urgently needed.

Microalbuminuria Reduction with Telmisartan in Normotensive and Hypertensive Japanese Patients with Type 2 Diabetes: A Post-Hoc Analysis of the Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) Study

“…In Japan, type 2 diabetic nephropathy is the main cause of chronic kidney disease (1,13). Furthermore, nephropathy accounts for a greater propor- tion of deaths in Japanese patients with type 2 diabetes than in their Caucasian counterparts (11)(12)(13)(14)(15). In the present post-hoc analysis of the INNOVATION study, we investigated whether or not treatment with telmisartan elicits beneficial effects on the progression of microalbuminuria in Japanese normotensive patients with type 2 diabetes.…”

“…However, no comprehensive largescale study has investigated whether or not angiotensin blockade prevents the progression of albuminuria in normotensive Japanese patients with type 2 diabetes. This investigation should be particularly important because it has been revealed that Japanese diabetic patients are much more susceptible than Caucasians to end-stage renal disease (11)(12)(13)(14)(15). We recently reported on the Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study to examine the effect of telmisartan, an ARB, on the progression of microalbuminuria in Japanese patients with type 2 diabetes (22,23).…”

“…Although epidemiological and familial studies indicate that there are obvious different genetic susceptibilities to endstage renal disease among ethnic groups (11)(12)(13)(14)(15), most national guideline groups have recommended ARBs or ACEIs instead of other antihypertensive agents in hypertensive patients with diabetic nephropathy (16)(17)(18)(19). Recent studies also provide evidence that treatment with ARBs or ACEIs results in long-term stabilization or normalization of albuminuria in normotensive type 2 diabetic patients (8-10, 20, 21).…”

Adiponectin gene (ADIPOQ) polymorphisms correlate with the progression of nephropathy in Taiwanese male patients with type 2 diabetes

“…A global study has reported that the overall prevalence of albuminuria in T2D to be about 50% [3]. Asian and Hispanic patients have the highest prevalence of albuminuria (55%), while Caucasians have the lowest (40.6%) [3], indicating possible ethnic differences. The pathogenesis of DN is multifactorial, and thought to come about as a result of environmental and genetic factors [4].…”

Increased protein damage in renal glomeruli, retina, nerve, plasma and urine and its prevention by thiamine and benfotiamine therapy in a rat model of diabetes

“…The current global epidemic of diabetes is expected to lead to a later increased global burden of vascular complications of diabetes [1]. Vascular complications develop progressively after 5-40 years of diabetes, although they may appear earlier in type 2 diabetes associated with a preceding period of undiagnosed diabetes and impaired glucose tolerance.…”