Increased urinary albumin excretion and its associations in the WHO Multinational Study of Vascular Disease in Diabetes

Aim/hypothesis. We aimed to determine variations in the prevalence of increased urinary albumin excretion, associated risk factors and complications in patients with diabetes participating in the WHO Multinational Study of Vascular Disease in Diabetes follow-up. Methods. Urinary albumin to urinary creatinine ratios were measured centrally in 2033 of the 2550 (79.7%) re-examined patients from eight centres in seven countries and the frequency of microalbuminuria and macroalbuminuria and their associations with risk factors and complications were examined. Results. Macroalbuminuria prevalence (overall 15.6%) varied tenfold (3-37%) among centres, was higher in American Indian and Asian centres and not clearly related to type of diabetes. Microalbuminuria (overall 19.7%) varied less (12-31%). Increased albumin excretion was related overall to baseline fasting plasma glucose in the pooled group in whom it was measured and to increased arterial pressure, insulin use, coronary heart disease, lower extremity amputation, retinopathy and stroke in most centres. Conclusion/interpretation. Centres varied widely in the prevalence of increased albumin excretion but associations with risk factors and vascular complications were generally similar in most centres and in both major types of diabetes with ethnic and genetic differences probably contributing.