Microalbuminuria: A Major Risk Factor in Non‐insulin‐dependent Diabetes. A 10‐year Follow‐up Study of 503 Patients

Abstract

The impact of microalbuminuria on mortality as well as other risk factors was investigated in a 10‐year follow‐up study of 503 predominantly non‐insulin‐dependent diabetic patients of whom 265 had died. Using Cox's regression analysis the prognostic influence of age, sex, age at diagnosis, known diabetes duration, blood pressure, fasting plasma glucose, relative weight, serum creatinine, retinopathy, and treatment was evaluated as well as morning urine albumin concentration (UAC) in four categories, i.e. UAC 15 μg/ml (normal), 15 μg/ml < UAC 40 μg/ml, 40 μg/ml < UAC 200 μg/ml and UAC > 200 μg/ml. Age, UAC, known duration, and serum creatinine were the only significant risk factors. After correction for the other three independent risk factors, the hazard ratios in the elevated UAC categories relative to the group with UAC 15 μg/ml were 1.53 (p = 0.007), 2.28 (p = 0.000002), and 1.82 (p = 0.02). The statistically significant correlations with UAC were: age (r = 0.09, p < 0.05), duration (r = 0.14, p < 0.01), systolic blood pressure (r = 0.12, p < 0.01), serum creatinine (r = 0.33, p < 0.001), and fasting plasma glucose (r = 0.12, p < 0.01). Increased UAC was associated also with retinopathy (p = 0.01). Fifty‐eight per cent of the deaths were caused by cardiovascular disease or stroke; only 3% died from uraemia. A reinvestigation including blood pressure, fasting plasma glucose, and UAC was made on 208 survivors.