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.
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Abbreviations
- AER:
-
Albumin excretion rate
- ACR:
-
Albumin-to-creatinine ratio
- CVD:
-
Cardiovascular disease
- eGFR:
-
Estimated glomerular filtration rate
- DM:
-
Diabetes mellitus
- T2DM:
-
Type 2 DM
- RIACE:
-
Renal insufficiency and cardiovascular events
- NA:
-
Normal albuminuria
- LA:
-
Low albuminuria
- T1DM:
-
Type 1 DM
- ROADMAP:
-
Randomised Olmesartan and Diabetes Microalbuminuria Prevention
- BP:
-
Blood pressure
- BMI:
-
Body mass index
- MS:
-
Metabolic syndrome
- HbA1c :
-
Haemoglobin A1c
- CKD:
-
Chronic kidney disease
- DR:
-
Diabetic retinopathy
- OHA:
-
Oral hypoglycaemic agents
- RAS:
-
Renin–angiotensin system
- DHP:
-
Dihydropyridine
- PP:
-
Pulse pressure
- OR:
-
Odds ratio
- CI:
-
Confidence interval
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Acknowledgments
The authors thank the RIACE Investigators for participating in this study (see the complete list as online Appendix).
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This work was supported by the Research Foundation of the Italian Society of Diabetology (Fo.Di.Ri) and the Diabetes, Endocrinology, and Metabolism (DEM) Foundation, and by unconditional grants from Eli-Lilly, Takeda, Chiesi Farmaceutici and Boehringer-Ingelheim. The sponsors had no role in design and conduct of the study; collection, management, and interpretation of the data; or preparation, review, and approval of the manuscript.
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The authors declare no relevant conflict of interest to disclose.
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The study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments. The protocol was approved by the locally appointed ethics committees, and participants gave informed consent.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
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Informed consent was obtained from all patients for being included in the study.
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Penno, G., Solini, A., Zoppini, G. et al. 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 52, 971–981 (2015). https://doi.org/10.1007/s00592-015-0789-x
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DOI: https://doi.org/10.1007/s00592-015-0789-x