Albuminuria and Heart Disease for Diabetes Patients With Kidney Disease

de Zeeuw D, Remuzzi G, Parving HH, et al.: Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation110:921-928, 2004.

What is the problem and what is known about it so far?

Albumin is a protein found in the urine. Albuminuria is when the amount of albumin in the urine is too high. Having albuminuria is a sign of also having nephropathy (diabetic kidney disease).

Albuminuria can also be a sign of cardiovascular disease (disease of the heart and blood vessels) in people with type 2 diabetes.

Researchers asked if lowering albumin in diabetic patients with kidney disease would help protect them from heart disease.

Who was studied?

A total of 1,513 participants with type 2 diabetes and kidney disease from an earlier study. At the start of the study, none had a heart or blood vessel problem (like stroke, heart surgery, or other heart procedures). All participants had too much albumin in their urine.

How was the study done?

In the earlier study, participants were put into one of two groups. One group was treated with losartan, a medication for high blood pressure. The other group was given a placebo (a "fake" pill). Participants did not know which pill they were getting. They took their medications for 6 months.

In this study, researchers noted if participants had a high, middle, or low amount of albumin in their urine. They looked to see who had heart and blood vessel problems in the following 3 to 4 years.

What did the researchers find?

The people in the high and middle groups had more heart and blood vessel problems. The higher the person's level of albumin in their urine, the more likely they were to have heart and blood vessel problems.

What were the limitations of the study?

The earlier study was not meant to focus on the link between albuminuria and cardiovascular risk.

What are the implications of the study?

People with type 2 diabetes and kidney disease should find out if the level of albumin in their urine is too high. If it is, lowering it may reduce their risk of heart disease.