Microalbuminuria in patients with Type 2 diabetes mellitus from general practice: course and predictive value.
OBJECTIVE
To assess the course of microalbuminuria in patients with Type 2 diabetes mellitus in general practice and the predictive value of urinary albumin concentration on all-cause mortality, cardiovascular mortality and cardiovascular morbidity.


METHODS
Cohort study in Type 2 diabetic patients tested for microalbuminuria in 1992, and re-tested in 1998. During follow-up all cardiovascular morbidity and mortality were recorded.


RESULTS
Of the original sample of 317 patients, 163 patients were re-tested. The mean change in urinary albumin concentration was +16.2 mg/l (range -122.0 to +602 mg/l). Seventy-five per cent of the patients without microalbuminuria in 1992 still had no microalbuminuria in 1998 and 40% of those with microalbuminuria in 1992 reverted to normoalbuminuria in 1998. Cox survival analysis, stratified for age, showed that microalbuminuria at baseline resulted in a risk ratio of all-cause mortality of 1.4 (95% confidence interval 0.8-2.7), of cardiovascular mortality of 1.2 (0.5-2.8) and of new cardiovascular events (including cardiovascular mortality) of 1.4 (0.8-2.3).


CONCLUSIONS
In the majority of patients the change of urinary albumin excretion was small, but the range was wide. A weak non-significant relationship between microalbuminuria and all-cause mortality and cardiovascular morbidity was observed.
Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands. W.deGrauw@hsv.kun.nl
W J
WJ
de Grauw
E H
EH
van de Lisdonk
W H
WH
van Gerwen
M
M
Verstappen
H J
HJ
van den Hoogen
J L
JL
Willems
C
C
van Weel
D000368:Aged; D000419:Albuminuria; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology* / Q000652:urine*; D003925:Diabetic Angiopathies / Q000401:mortality; D005194:Family Practice; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D012016:Reference Values; D016019:Survival Analysis