The assessment and management of albuminuria in primary care.
BACKGROUND
While CKD is a common finding in patients with type 2 diabetes, the clinical response to its identification is often problematic. This study aims to determine the frequency of albuminuria in patients with type 2 diabetes in the primary care setting and examine the factors which influence its management.


METHODS
Expressions of interest were invited from all registered GPs across Australia, from whom 500 investigators were randomly selected. Investigators were requested to document the clinical characteristics of 10-15 consecutively presenting patients with type 2 diabetes. Results from the most recent urinalysis were classified according to guidelines, then systematically compared to classifications provided by GPs themselves and their management strategies.


RESULTS
One in three patients had an elevated urinary albumin excretion (UAE, 34.6%, 95% CI, 33.3-35.9%) on their most recent urinalysis. The presence of microalbuminuria or proteinuria, as identified by the GP, was not associated with a perceived increase in cardiovascular risk. In addition, the use of aspirin and the prescribing of agents to block the RAS were not significantly linked to UAE. Similarly, the perceived adequacy of blood pressure control was not significantly different whether or not microalbuminuria or proteinuria was identified to be present.


CONCLUSIONS
An elevated UAE is a common finding in general practice. However, it fails to significantly influence their clinical care. Additional education to ensure appropriate case recognition and management of kidney disease is needed, focusing on the significance of albuminuria to the care of patients with type 2 diabetes.
Thomas
Merlin C
MC
Danielle Alberti Memorial Centre for Diabetic Complications, Baker Medical Research Institute, P.O. Box 6492, Melbourne, Victoria 8008, Australia. Merlin.Thomas@baker.edu.au
D000368:Aged; D000419:Albuminuria / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D012727:Sex Characteristics; D016482:Urinalysis
D001786:Blood Glucose; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin