December 1, 2001Open Access
Rapid Progression of Albumin Excretion Is an Independent Predictor of Cardiovascular Mortality in Patients With Type 2 Diabetes and Microalbuminuria
Key Result
Progression of microalbuminuria significantly predicted all-cause mortality (HR 1.46 per point increase per year, P<0.001) and coronary heart disease mortality (HR 2.32, P=0.006).
Study Design
Type
Cohort (n=58)
Structured PICO
Does the rate of progression of microalbuminuria predict mortality in patients with type 2 diabetes and microalbuminuria?
P
Population
58 patients with type 2 diabetes and microalbuminuria followed for a median of 7 years.
E
Exposure
Progression of microalbuminuria (expressed as mean yearly change in albumin-to-creatinine ratio)
O
Outcome
All-cause mortality and coronary heart disease mortalityhard clinical
In patients with type 2 diabetes and microalbuminuria, the rate of progression of albumin excretion is a powerful independent predictor of mortality, primarily from coronary heart disease.
Main Result
Hazard Ratio: 1.46
p-value: p=<0.001
Abstract
OBJECTIVE: In patients with type 2 diabetes, microalbuminuria is associated with an increase in predominantly cardiovascular mortality. Considerable interindividual variability in the rate of progression of microalbuminuria exists. The prognostic significance of rate of progression of microalbuminuria with regard to cardiovascular and renal clinical end points is, however, unknown. The purpose of this study was to determine the prognostic significance of rate of progression of microalbuminuria for cardiovascular end points and renal function. RESEARCH DESIGN AND METHODS: In a previous prospective cohort study, progression of microalbuminuria (expressed as mean yearly change in albumin-to-creatinine ratio) was assessed in 58 patients with type 2 diabetes. During a median follow-up of 7 years after progression of microalbuminuria was determined, we registered all-cause mortality and coronary heart disease mortality as primary end points and coronary heart disease (fatal or nonfatal), peripheral vascular disease, ischemic stroke, retinopathy, macroalbuminuria, and change in serum creatinine as secondary end points. RESULTS: Seven subjects died during the study; five of these subjects died of coronary heart disease. Cox's regression analysis identified progression of microalbuminuria as a significant predictor of all-cause mortality (hazard ratio 1.46 per point increase in albumin-to-creatinine ratio per year, P < 0.001), coronary heart disease mortality (hazard ratio 2.32, P = 0.006), and macroalbuminuria (hazard ratio 1.79, P < 0.001). Adjustment for multiple cardiovascular risk factors did not affect these results. Identical analyses for baseline level of microalbuminuria instead of progression rate of microalbuminuria did not show significant hazard ratios. In addition, progression of microalbuminuria significantly predicted an increase in serum creatinine (r = 0.29, P = 0.04). CONCLUSIONS: In patients with type 2 diabetes and microalbuminuria, the rate of progression of albumin excretion seems to be a powerful independent predictor of mortality caused mainly by coronary heart disease.