Dr. Jonathan E. Shaw, co-author, from International Diabetes Institute, Caulfield, Victoria, Australia stated that, "The presence of a recognized cardiovascular disease risk factor (albuminuria) prior to the development of diabetes calls for screening for diabetes and pre-diabetes."

Dr. Shaw and colleagues used data from the Australian Diabetes, Obesity, and Lifestyle study, which included 11,247 randomly selected adults 25 years of age or older, to examine factors associated with albuminuria and to examine its association with the early stages of glucose intolerance.

Microalbuminuria was more prevalent among patients with impaired fasting glucose (8.3%), impaired glucose tolerance (9.9%), newly diagnosed diabetes (15.4%), and established diabetes (26.5%) than among individuals with normal glucose tolerance (4.3%), the authors report.

The increased risk of albuminuria remained after adjustment for age, sex, and other known albuminuria risk factors except among patients with impaired glucose tolerance, the report indicates.

Among patients with new-onset or established diabetes, diabetes duration, age, body-mass index, systolic blood pressure, smoking, and glycosylated hemoglobin level were independently associated with the risk of albuminuria, the researchers note. Triglyceride level was an additional independent risk factor in patients with established diabetes.

"The increased risk for albuminuria was evident among persons with impaired fasting glucose and newly diagnosed diabetes," the investigators conclude, "suggesting that the development of albuminuria commences early in the onset of diabetes."

"Modifiable risk factors (such as hemoglobin A1c and hypertension) are independent risk factors for albuminuria," Dr. Shaw said. "Treating them aggressively should help to reduce the burden of cardiovascular and renal disease."

These study findings "remind us that increased urine albumin excretion is not unique to adults with diabetes mellitus and may be seen in a substantial proportion of adults without diabetes mellitus as well," writes Dr. Holly Kramer from Loyola Medical Center, Maywood, Illinois in a related editorial.

"However, it must be emphasized that screening tests for chronic kidney disease in adults with diabetes mellitus should include the measurement of serum creatinine for the estimation of glomerular filtration rate in addition to urine albumin excretion, to maximize the sensitivity of our screening tests."

Source: Diabetes In Control.com: Am J Kidney Dis 2004;44:792-798,921-923.