Proteinuria predicts 10-year cancer-related mortality in patients with type 2 diabetes

J Diabetes Complications. May-Jun 2013;27(3):201-7. doi: 10.1016/j.jdiacomp.2012.11.007. Epub 2013 Jan 18.

Abstract

Background: We conducted a cohort study to determine if proteinuria predicts cancer-related mortality in type 2 diabetic subjects.

Methods: Between July 1996 and June 2003, we enrolled 646 type 2 diabetic subjects. Participants were followed-up until December 31, 2008. The vital status was ascertained by linking records with computerized death certificates in Taiwan.

Results: During a median follow-up of 10.4 years, 158 subjects had died, including 59 from cancers. Subjects with proteinuria had a hazard ratio (HR) of 2.77 (95% CI 1.82-4.21) for all-cause mortality and 1.99 (95% CI 1.00-3.94) for cancer-related mortality after adjustment for demographic factors and medical conditions. Specifically, proteinuria showed a trend of increased colon cancer death. The presence of proteinuria significantly improved the predictive ability of cancer-related mortality (increase in concordance statistics or area under the ROC curve=0.03). Patients with both proteinuria and estimated glomerular filtration rate <60 ml/min per 1.73 m² showed higher HR for all-cause mortality than patients with proteinuria only (adjusted HRs (95% CI), 4.01 (2.42-6.67) vs. 2.69 (1.51-4.79), both p<0.01).

Conclusions: Proteinuria can predict 10-year all-cause and cancer-related mortalities independently in type 2 diabetic subjects, over and above the established risk factors associated with type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Colonic Neoplasms / complications
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / physiopathology
  • Colonic Neoplasms / urine
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetic Nephropathies / complications*
  • Diabetic Nephropathies / epidemiology
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Mortality
  • Neoplasms / complications*
  • Neoplasms / mortality
  • Neoplasms / physiopathology
  • Neoplasms / urine
  • Prospective Studies
  • ROC Curve
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / epidemiology
  • Risk Factors
  • Survival Analysis
  • Taiwan / epidemiology