THE ASSOCIATION OF MICROALBUMINURIA AND MORTALITY IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS - A SYSTEMATIC OVERVIEW OF THE LITERATURE

Objectives: To critically analyze the literature linking microalbuminu ria with total and cardiovascular mortality and cardiovascular morbidi ty in non-insulin-dependent diabetes mellitus (NIDDM) and to quantify the risk. Methods: A combination of retrieval techniques (MEDLINE, SCI SEARCH, and handsearching published bibliographies) was used to find a ll relevant articles based on title and abstract and ''Methods'' secti ons. Unpublished data on albumin excretion rate were sought from large NIDDM cohort studies. Results: A total of 264 citations were retrieve d, of which 11 cohort studies were selected for inclusion in the overv iew, representing a total of 2138 patients followed up for a mean of 6 .4 years. Patient age was similar across cohorts. Duration of NIDDM ra nged from newly diagnosed to 13 years. The prevalence of microalbuminu ria ranged from 20% to 36% in the 8 cohorts that excluded patients wit h clinical proteinuria. All studies reported either a trend or a signi ficant association between microalbuminuria and total mortality or car diovascular morbidity or mortality the overall odds ratio for death wa s 2.4 (95% confidence interval, 1.8-3.1) and for cardiovascular morbid ity or mortality, 2.0 (95% confidence interval, 1.4-2.7). We found no evidence of reporting bias. Conclusion: Microalbuminuria is a strong p redictor of total and cardiovascular mortality and cardiovascular morb idity in patients with NIDDM.