Grant: Travel Awards - Institute Community Support

Diabetes is the leading cause of kidney failure and a major cause of heart disease and stroke. As patients with diabetes are associated with poor long-term outcomes compared to the general population, effective methods to identify and appropriately monitor patients at risk of developing adverse outcomes are required. Albuminuria (protein in the urine) is an early marker of kidney and cardiovascular disease and there is strong evidence showing that higher levels of albuminuria are associated with increased risk of kidney disease, cardiovascular disease, and death. However, it is unknown whether a patient's risk of adverse outcomes is altered by changes in albuminuria, something that happens frequently in clinical practice. If so, this has important future implications for reducing or preventing future risk of poor outcomes as monitoring albuminuria could be used as an effective strategy for patient management. Our study, which assessed whether change in albuminuria was associated with the risk of all-cause death using data from a large randomized controlled trial of 9193 type 2 diabetes patients, showed that a 25% or more increase in albuminuria over 2 years was associated with 31% higher mortality when compared to minor changes in albuminuria. A decrease of 25% or more, however, was not associated with the risk of death when compared to those who experienced a minor change. Our overall results suggest that a substantial change in albuminuria may be a potential prognostic marker for death and that monitoring albuminuria may be an effective strategy to help estimate future risk of adverse outcomes.