What characteristics are associated with screening positive for microalbuminuria in patients with diabetes in the community?

Abstract

The community prevalence of microalbuminuria in patients with diabetes is unknown. The aims of this study were to determine the community prevalence of microalbuminuria and to identify associated characteristics with particular reference to ethnicity. The study was undertaken in 18 Leicestershire general practices. Subjects were recruited either by a written invitation to the entire diabetic register over 16 years of age or by personal invitation to all those attending a practice diabetic clinic. Microalbuminuria status was determined from three first morning urine specimens, using the albumin:creatinine ratio (ACR), microalbuminuria being defined as at least 2.5mg/mmol in males and 3.5mg/mmol in females in two or more samples. Nine patient covariates were recorded for each subject. In all, 1860 patients (an estimated overall response rate of 67%) consented to participate (1373 white, 451 Indo-Asian, 36 other ethnic groups); 1362 (73.2%) completed screening. The prevalence of microalbuminuria in patients with diabetes recruited to the study was 19.3%. The characteristics independently associated with a higher prevalence of microalbuminuria were current insulin use, current smoking, older age, higher systolic blood pressure and poorer metabolic control, but there was no significant association with duration of diabetes, gender or ethnicity. Screening for microalbuminuria using ACR is feasible in the community. Our estimate of the community-wide prevalence of microalbuminuria (19.3%) is lower than some earlier population- and many hospital-based estimates. Due to difficulties in recruiting, in particular Indo-Asian subjects, the precise community prevalence of microalbuminuria could only be estimated, although some characteristics of the screened population were representative of the larger unscreened Leicestershire diabetic population. The factors shown to be associated with microalbuminuria were current insulin use, current smoking, older age, higher systolic blood pressure and poorer metabolic control. If Indo-Asian ethnicity is associated with microalbuminuria, then this association is not as strong as other characteristics. These findings suggest that interventions to delay the progression of diabetic nephropathy support smoking cessation, and better glycaemic and blood pressure control - areas that require sustained action. Copyright © 2004 John Wiley & Sons, Ltd.