[Skip to Content]
[Skip to Content Landing]
Article
July 14, 1997

The Association of Microalbuminuria and Mortality in Non—Insulin-Dependent Diabetes Mellitus: A Systematic Overview of the Literature

Author Affiliations
From the Division of Endocrinology, Mayo Clinic, Rochester, Minn (Dr Dinneen), and the Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario (Dr Gerstein).
Arch Intern Med. 1997;157(13):1413-1418. doi:10.1001/archinte.1997.00440340025002
Abstract

Objectives:  To critically analyze the literature linking microalbuminuria with total and cardiovascular mortality and cardiovascular morbidity in non—insulin— dependent diabetes mellitus (NIDDM) and to quantify the risk.

Methods:  A combination of retrieval techniques (MEDLINE, SCISEARCH, and handsearching published bibliographies) was used to find all relevant articles based on title and abstract and "Methods" sections. Unpublished data on albumin excretion rate were sought from large NIDDM cohort studies.

Results:  A total of 264 citations were retrieved, of which 11 cohort studies were selected for inclusion in the overview, representing a total of 2138 patients followed up for a mean of 6.4 years. Patient age was similar across cohorts. Duration of NIDDM ranged from newly diagnosed to 13 years. The prevalence of microalbuminuria ranged from 20% to 36% in the 8 cohorts that excluded patients with clinical proteinuria. All studies reported either a trend or a significant association between microalbuminuria and total mortality or cardiovascular morbidity or mortality; the overall odds ratio for death was 2.4 (95% confidence interval, 1.8-3.1) and for cardiovascular morbidity or mortality, 2.0 (95% confidence interval, 1.4-2.7). We found no evidence of reporting bias.

Conclusion:  Microalbuminuria is a strong predictor of total and cardiovascular mortality and cardiovascular morbidity in patients with NIDDM.Arch Intern Med. 1997;157:1413-1418

References
1.
Mogensen CE, Chachati A, Christensen CK, et al.  Microalbuminuria: an early marker of renal involvement in diabetes .  Uremia Invest. 1985-1986; 9:85-95.
2.
Mogensen CE, Damsgaard EM, Froland A, Nielsen S, de Fine Olivarius N, Schmitz A.  Microalbuminuria in non-insulin dependent diabetes .  Clin Nephrol. 1992;38:528-538.
3.
Alzaid AA.  Microalbuminuria in patients with NIDDM: an overview .  Diabetes Care. 1996;19:79-89.Crossref
4.
Bennett PH, Haffner S, Kasiske BL, et al.  Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation .  Am J Kidney Dis. 1995;25:107-112.Crossref
5.
Mogensen CE.  Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes .  N Engl J Med. 1984;310:356-360.Crossref
6.
Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ.  Microalbuminuria predicts mortality in non-insulin-dependent diabetes .  Diabet Med. 1984;1:17-19.Crossref
7.
Jensen T, Borch-Johnsen K, Kofoed-Enevoldsen A, Deckert T.  Coronary heart disease in young type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors .  Diabetologia. 1987;30:144-148.Crossref
8.
Yudkin JS, Forrest RD, Jackson CA.  Microalbuminuria as predictor of vascular disease in nondiabetic subjects .  Lancet. 1988;2:530-533.Crossref
9.
Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A.  Albuminuria reflects widespread vascular damage: the Steno hypothesis .  Diabetologia. 1989;32:219-226.Crossref
10.
Deckert T, Kofoed-Enevoldsen A, Norgaard K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen T.  Microalbuminuria: implications for micro and macrovascular disease .  Diabetes Care. 1992;15:1181-1191.Crossref
11.
Gilbert RE, Cooper ME, McNally PC, O'Brien RC, Toft J, Jerums G.  Microalbuminuria: prognostic and therapeutic implications in diabetes mellitus .  Diabet Med. 1994;11:636-645.Crossref
12.
Breslow NE, Day NE.  Statistical methods in cancer research: the analysis of case-control studies .  IARC Sci Publ. 1980;1:122-159.
13.
Schmitz A, Vaeth M.  Microalbuminuria: a major risk factor in non-insulin-dependent diabetes: a 10-year follow-up study of 503 patients .  Diabet Med. 1988;5:126-134.Crossref
14.
Patrick AW, Leslie PJ, Clarke BF, Frier BM.  The natural history and associations of microalbuminuria in type 2 diabetes during the first year after diagnosis .  Diabet Med. 1990;7:902-908.Crossref
15.
Stiegler H, Standl E, Schulz K, Roth R, Lehmacher W.  Morbidity, mortality, and albuminuria in type 2 diabetic patients: a three-year prospective study of a random cohort in general practice .  Diabet Med. 1992;9:646-653.Crossref
16.
Mattock MB, Morrish NJ, Viberti GC, Keen H, FitzGerald AP, Jackson G.  Prospective study of microalbuminuria as predictor of mortality i n  NIDDM. Diabetes. 1992;41:736-741.Crossref
17.
Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE.  Eight to nine year mortality in known non-insulin dependent diabetics and controls .  KidneyInt. 1992;41:731-735.
18.
Stehouwer CDA, Nauta JJP, Zeldenrust GC, Hackeng WHL, Donker AJM, Den Ottolander GJH.  Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus .  Lancet. 1990;340:319-323.Crossref
19.
Niskanen L, Voutilanen R, Terasvirta M, et al.  A prospective study of clinical and metabolic associates of proteinuria in patients with type 2 diabetes mellitus .  Diabet Med. 1993;10:543-549.Crossref
20.
Standl E, Stiegler H.  Microalbuminuria in a random cohort of recently diagnosed type 2 (non-insulin-dependent) diabetic patients living in the greater Munich area .  Diabetologia. 1993;36:1017-1020.Crossref
21.
Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE.  Prognostic value of urinary albumin excretion rate and other risk factors in elderly diabetic patients and non-diabetic control subjects surviving the first 5 years after assessment .  Diabetologia. 1993;36:1030-1036.Crossref
22.
Uusitupa MIJ, Niskanen LK, Siitonen O, Voutilainen E, Pyorala K.  Ten-year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in type 2 (non-insulin-dependent) diabetic and non-diabetic subjects .  Diabetologia. 1993;36:1175-1184.Crossref
23.
Neil A, Hawkins M, Potok M, Thorogood M, Cohen D, Mann J.  A prospective population-based study of microalbuminuria as a predictor of mortality i n  NIDDM. Diabet Care. 1993;16:996-1003.Crossref
24.
Macleod JM, Lutale J, Marshall SM.  Albumin excretion and vascular deaths in NIDDM .  Diabetologia. 1995;38:610-616.Crossref
25.
Beatty OL, Ritchie CM, Bell PM, Hadden DR, Kennedy L, Atkinson AB.  Microalbuminuria as identified by a spot morning urine specimen in non-insulin-treated diabetes: an eight-year follow-up study .  Diabet Med. 1995;12:261-266.Crossref
26.
Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H.  Mortality from coronary heart disease and stroke in relation to degree of glycemia: the Whitehall Study .  BMJ. 1983;287:867-870.Crossref
27.
Nosadini R, Solini A, Velussi M, et al.  Impaired insulin-induced glucose uptake by extrahepatic tissue is hallmark of NIDDM patients who have or will develop hypertension and microalbuminuria .  Diabetes. 1994;43:491-499.Crossref
28.
Niskanen L, Laakso M.  Insulin resistance is related to microalbuminuria in patients with type 2 (non-insulin-dependent) diabetes mellitus .  Metabolism. 1993;42:1541-1545.Crossref
29.
Viberti G, Mogensen CE, Groop LC, Pauls JF.  Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria .  JAMA. 1994; 271:275-279.Crossref
30.
Lewis EJ, Hunsicker LG, Bain RP, Rohde RP.  The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy: the Collaborative Study Group .  N Engl J Med. 1993;329:1456-1462.Crossref
31.
Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M.  Long-term stabilizing effect of angiotensinconverting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type 2 diabetic patients .  Ann Intern Med. 1994;118:577-581.Crossref
32.
The HOPE Study Investigators.  The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large simple randomized controlled trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events .  Can J Cardiol. 1996;12:127-137.
33.
Hypertension in Diabetes Study Group.  Hypertension in Diabetes Study III: prospective study of therapy of hypertension in type 2 diabetic patients: efficacy of ACE inhibition and β-blockade .  Diabet Med. 1994;11:773-782.Crossref
×