Independent correlates of urinary albumin excretion within the normoalbuminuric range in patients with type 2 diabetes: The Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study

Acta Diabetol. 2015 Oct;52(5):971-81. doi: 10.1007/s00592-015-0789-x. Epub 2015 Jul 10.

Abstract

Aims: Within the normoalbuminuric range, low albuminuria (LA, 10-29 mg/24 h) is associated with higher adverse cardiovascular and renal outcomes than normal albuminuria (NA, <10 mg/24 h). This cross-sectional analysis of the cohort from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study was aimed at assessing the independent correlates of LA versus NA in patients with type 2 diabetes.

Methods: This analysis involved 11,538 normoalbuminuric patients (73.2 % of the entire RIACE cohort): 6023 (52.2 %) with NA and 5515 (47.8 %) with LA. Binary logistic regression analysis with backward conditional variable selection was applied to assess the independent correlates of LA versus NA.

Results: Compared with NA subjects, LA patients were more frequently males, older and with family history of hypertension, had longer diabetes duration, lower HDL cholesterol, and higher haemoglobin (Hb) A1c, triglycerides, and blood pressure (BP), use of anti-hyperglycaemic and anti-hypertensive drugs, and prevalence of metabolic syndrome, retinopathy, chronic kidney disease, any cardiovascular disease, myocardial infarction, and coronary and peripheral events. Men with LA were also more frequently current or former smokers and had higher body mass index, waist circumference, and non-HDL cholesterol. Independent correlates of LA were age (OR 1.018), family history of hypertension (OR 1.321), smoking status (former, OR 1.158; current, OR 1.237), HbA1c (OR 1.062), waist circumference (OR 1.050), triglycerides (OR 1.001), and diastolic BP (OR 1.014), together with use of anti-hyperglycaemic and anti-hypertensive agents.

Conclusions: Several risk factors are associated with increased albuminuria within the normoalbuminuric range. As most of these factors are potentially modifiable, treating them aggressively might reduce the excess risk associated with LA.

Trial registration: NCT00715481; www.ClinicalTrials.gov .

Keywords: Albumin excretion rate; Chronic kidney disease; Diabetic retinopathy; Type 2 diabetes; eGFR.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / epidemiology
  • Albuminuria / urine*
  • Blood Pressure
  • Body Mass Index
  • Cholesterol, HDL / blood
  • Cross-Sectional Studies
  • Diabetes Complications / epidemiology
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / urine*
  • Diabetic Cardiomyopathies / epidemiology
  • Diabetic Cardiomyopathies / urine*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / urine*
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Reference Values
  • Triglycerides / blood

Substances

  • Cholesterol, HDL
  • Glycated Hemoglobin A
  • Triglycerides

Associated data

  • ClinicalTrials.gov/NCT00715481