Identifying patients with type 2 diabetes at high risk of microalbuminuria: Results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study

Maria C E Rossi, Antonio Nicolucci, Fabio Pellegrini, Marco Comaschi, Antonio Ceriello, Domenico Cucinotta, Carlo Giorda, Umberto Valentini, Giacomo Vespasiani, Salvatore De Cosmo

Research output: Contribution to journalArticlepeer-review

Abstract

Background. We evaluated to what extent the presence of risk factors and their interactions increased the likelihood of microalbuminuria (MAU) among individuals with type 2 diabetes. Methods. Fifty-five Italian diabetes outpatient clinics enrolled a sample of patients with type 2 diabetes, without urinary infections and overt diabetic nephropathy. A morning spot urine sample was collected to centrally determine the urinary albumin/creatinine ratio (ACR). A tree-based regression technique (RECPAM) and multivariate analyses were performed to investigate interaction between correlates of MAU. Results. Of the 1841 patients recruited, 228 (12.4%) were excluded due to the presence of urinary infections and 56 (3.5%) for the presence of macroalbuminuria. Overall, the prevalence of MAU (ACR = 30-299 mg/g) was of 19.1%. The RECPAM algorithm led to the identification of seven classes showing a marked difference in the likelihood of MAU. Non-smoker patients with HbA1c 98 cm and HbA1c >8% showed the highest likelihood of MAU (odds ratio = 13.7; 95% confidence intervals 6.8-27.6). In the other classes identified, the risk of MAU ranged between 3 and 5. Age, systolic blood pressure, HDL cholesterol levels and diabetes treatment represented additional, global correlates of MAU. Conclusions. The likelihood of MAU is strongly related to the interaction between diabetes severity, smoking habits and several components of the metabolic syndrome. In particular, abdominal obesity, elevated blood pressure levels and low HDL cholesterol levels substantially increase the risk of MAU. It is of primary importance to monitor MAU in high-risk individuals and aggressively intervene on modifiable risk factors.

Original languageEnglish
Pages (from-to)1278-1284
Number of pages7
JournalNephrology Dialysis Transplantation
Volume23
Issue number4
DOIs
Publication statusPublished - Apr 2008

Keywords

  • Cardiovascular risk
  • Microalbuminuria
  • Prevalence
  • RECPAM analysis
  • Type 2 diabetes

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Medicine(all)

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