Prediction of cardiovascular events, diabetic nephropathy, and mortality by albumin concentration in a spot urine sample in patients with type 2 diabetes

Journal of Diabetes and its Complications, 06/12/2012

Viana LV et al. – Random urinary albumin concentration (UAC) ≥14mg/l predicted cardiovascular events, diabetic nephropathy, and mortality just as well as albumin:creatinine ratio (ACR). UAC may be used to assess cardiovascular and renal risks in patients with type 2 diabetes.

Methods

  • In this cohort, urinary albumin (immunoturbidimetry) was measured as 24-h urinary albumin excretion (UAE) and, in a random spot urine, as UAC and albumin:creatinine ratio (ACR).
  • Primary outcomes were:
    • 1) cardiovascular events,
    • 2) DN defined as a composite outcome [macroalbuminuria and/or decreased glomerular filtration rate (GFR) <60ml/min/1.73m2],
    • 3) death.

Results

  • A total of 199 type 2 diabetic patients, aged 59.9±9.9years, were followed for 6.1±2.7years.
  • UAC ≥14.4mg/l, as determined by ROC curve, predicted DN and prediction for this and other outcomes were compared with traditional microalbuminuria cutoffs for ACR and UAE.
  • The outcomes frequency was: cardiovascular events=26.4%, DN=31.7% (23.5% decreased GFR; 13.6% macroalbuminuria) and death=8.50%. In Cox analyses, UAC ≥14mg/l increased the risk (hazard ratio, HR) for cardiovascular events 3.25 times (95% CI 1.43–7.38; P=0.005), 4.30 for DN composite outcome (95% CI 2.22–8.32; P<0.001), and 5.51 for death (95% CI 1.16–26.22; P=0.032).
  • Corresponding HRs of ACR ≥30mg/g were: 2.89 (95% CI 1.29–6.45; P=0.009) for cardiovascular events, 4.67 (95% CI 2.34–9.34; P<0.001) for DN composite outcome and 5.07 (95% CI 1.01–24.88; P=0.049) for death.
  • HRs of UAE ≥30mg/24-h were: 2.20 (95% CI 2.08–2.49; P=0.030) for cardiovascular events, 6.76 (95% CI 3.32–13.77; P<0.001) for DN composite outcome, and 2.47 (95% CI 0.72–8.42; P=0.150) for death.

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