PROGNOSTIC VALUE OF URINARY ALBUMIN EXCRETION RATE AND OTHER RISK-FACTORS IN ELDERLY DIABETIC-PATIENTS AND NONDIABETIC CONTROL SUBJECTS SURVIVING THE 1ST 5 YEARS AFTER ASSESSMENT

In 1981-1982 urinary albumin excretion rates were determined in 211 di abetic and 216 non-diabetic subjects aged 60-74 years. By April 1992 1 22 diabetic and 58 non-diabetic probands had died. Dividing the two st udy populations at an albumin excretion rate of 15 mug/min showed that 69.3 % of diabetic subjects with values at or above the limit, and 49 .9% of those with values below (log rank test p = 0.0082) had died. Th e corresponding values for non-diabetic subjects were 44.4 % and 21.0 %, respectively (log rank test p = 0.0002). In single factor log rank tests ischaemic heart disease and a low value of HDL were also predict ive of death in the diabetic population during a 10-11-year observatio n period. In the non-diabetic population ischaemic heart disease, hype rtension, and a serum creatinine level above the median value were pre dictive. In further log rank analyses probands dying during the first years, (e.g. the first 2 years)were removed from the calculations. The prognostic value of the above-mentioned factors diminished with time. In a Cox Regression analysis we found that the predictive value of ur inary albumin excretion rate to mortality had disappeared when subject s who had died during the first 5 years were removed from the analysis , whereas HDL in the diabetic patients and blood pressure and serum cr eatinine in non-diabetic subjects were still of significant predictive value. We therefore conclude that urinary albumin excretion rate is a more short-term predictor of mortality than previously thought, in co ntrast to HDL, hypertension and serum creatinine.