Determinants of urinary albumin excretion within the normal range in patients with type 2 diabetes: the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study.
OBJECTIVE
In contrast to microalbuminuric type 2 diabetic patients, the factors correlated with urinary albumin excretion are less well known in normoalbuminuric patients. This may be important because even within the normoalbuminuric range, higher rates of albuminuria are known to be associated with higher renal and cardiovascular risk.


METHODS
At the time of screening for the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) Study, the urinary albumin/creatinine ratio (UACR) was 0.44 mg/mmol in 4,449 type 2 diabetic patients. The independent correlates of UACR were analysed.


RESULTS
Independent correlates of UACR during baseline were (in descending order): night-time systolic BP (r(s) = 0.19); HbA(1c) (r(s) = 0.18); mean 24 h systolic BP (r(s) = 0.16); fasting blood glucose (r(s) = 0.16); night-time diastolic BP (r(s) = 0.12); office systolic BP, sitting (r(s) = 0.11), standing (r(s) = 0.10); estimated GFR (r(s) = 0.10); heart rate, sitting (r(s) = 0.10); haemoglobin (r(s) = -0.10); triacylglycerol (r(s) = 0.09); and uric acid (r(s) = -0.08; all p <or= 0.001). Significantly higher albumin excretion rates were found for the following categorical variables: higher waist circumference (more marked in men); presence of the metabolic syndrome; smoking (difference more marked in males); female sex; antihypertensive treatment; use of amlodipine; insulin treatment; family history of diabetes; and family history of cardiovascular disease (more marked in women).


CONCLUSIONS
Although observational correlations do not prove causality, in normoalbuminuric type 2 diabetic patients the albumin excretion rate is correlated with many factors that are potentially susceptible to intervention.


BACKGROUND
ClinicalTrials.gov ID no.: NCT00185159


BACKGROUND
This study was sponsored by Daichii-Sankyo.
Ritz
E
E
Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
Viberti
G C
GC
Ruilope
L M
LM
Rabelink
A J
AJ
Izzo
J L
JL
Katayama
S
S
Ito
S
S
Mimran
A
A
Menne
J
J
Rump
L C
LC
Januszewicz
A
A
Haller
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007093:Imidazoles / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D010919:Placebos; D012016:Reference Values; D013777:Tetrazoles / Q000627:therapeutic use*; D055815:Young Adult
D047228:Angiotensin II Type 1 Receptor Blockers; D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007093:Imidazoles; D010919:Placebos; D013777:Tetrazoles; C437965:olmesartan