Systematic review on urine albumin testing for early detection of diabetic complications

• Published in: Health technology assessment (Winchester, England) England), 2005-08, Vol.9 (30), p.iii-vi
• Main Authors: Newman, D J, Mattock, M B, Dawnay, A B S, Kerry, S, McGuire, A, Yaqoob, M, Hitman, G A, Hawke, C
• Format: Article
• Language: English
• Subjects: Age Factors; Albuminuria - diagnosis; Antihypertensive Agents - therapeutic use; Blood Glucose; Blood Pressure - drug effects; Diabetes Complications - diagnosis; Diabetes Complications - mortality; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - mortality; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology
• ISSN: 1366-5278; 2046-4924; 1366-5278
• DOI: 10.3310/hta9300

To determine whether microalbuminuria is an independent prognostic factor for the development of diabetic complications and whether improved glycaemic or blood pressure control has a greater influence on the development of diabetic complications in those with microalbuminuria than in those with normoalbuminuria. Electronic databases up until January 2002. A protocol for peer review by an external expert panel was prepared that included selection criteria for data extraction and required two independent reviewers to undertake article selection and review. Completeness was assessed using hand-searching of major journals. Random effects meta-analysis was used to obtain combined estimates of relative risk (RR). Funnel plots, trim and fill methods and meta-regression were used to assess publication bias and sources of heterogeneity. In patients with type 1 or type 2 DM and microalbuminuria there is a RR of all-cause mortality of 1.8 [95% confidence interval (CI) 1.5 to 2.1] and 1.9 (95% CI 1.7 to 2.1) respectively. Similar RRs were found for other mortality end-points, with age of cohort being inversely related to the RR in type 2 DM. In patients with type 1 DM, there is evidence that microalbuminuria or raised albumin excretion rate has only weak, if any, independent prognostic significance for the incidence of retinopathy and no evidence that it predicts progression of retinopathy, although strong evidence exists for the independent prognostic significance of microalbuminuria or raised albumin excretion rate for the development of proliferative retinopathy (crude RR of 4.1, 95% CI 1.8 to 9.4). For type 2 DM, there is no evidence of any independent prognostic significance for the incidence of retinopathy and little, if any, prognostic relationship between microalbuminuria and the progression of retinopathy or development of proliferative retinopathy. In patients with type 1 DM and microalbuminuria there is an RR of developing end-stage renal disease (ESRD) of 4.8 (95% CI 3.0 to 7.5) and a higher RR (7.5, 95% CI 5.4 to 10.5) of developing clinical proteinuria, with a significantly greater fall in glomerular filtration rate (GFR) in patients with microalbuminuria. In patients with type 2 DM, similar RRs were observed: 3.6 (95% CI 1.6 to 8.4) for developing ESRD and 7.5 (95% CI 5.2 to 10.9) for developing clinical proteinuria, with a significantly greater decline in GFR in the microalbuminuria group of 1.7 (95% CI 0.1 to 3.2) ml per minute per year compared with