Table 2.

Clinical studies reporting the risks associated with a positive microalbuminuria resulta

StudyPopulationMicroalbuminuria DefinitionRisk Associated with a Positive Microalbuminuria Result (95% CI)
Prospective studies
    HOPE (7)Subjects at high cardiovascular risk (≥55 yr with CVD or with diabetes + ≥1 CVD risk factor; n = 9043)ACR ≥2 mg/mmol in a first-morning spot urine sampleAll-cause mortality: RR 2.09 (1.84 to 2.38)
    PREVEND (8)Residents of Groningen, the Netherlands, 28 to 75 yr (n = 40,548)UAE 20 to 200 mg/L in an early-morning spot urine sampleCardiovascular death: RR 1.29 (1.18 to 1.40)Noncardiovascular death: RR 1.12 (1.04 to 1.21)
    PREVEND (21)Residents of Groningen, the Netherlands, 28 to 75 yr (n = 7330)UAE 30 to 300 mg in a 24-h urine sampleAll-cause mortality: HR 3.3 (1.5 to 7.1) for patients with ST-T segment changes + microalbuminuria versus 0.9 (0.4 to 1.9) for ST-T segment changes aloneCardiovascular death: HR 10.4 (2.5 to 43.6) for patients with ST-T segment changes + microalbuminuria versus 2.7 (0.6 to 12.3) for ST-T segment changes alone
    Hoorn Study (11)Population-based: White individuals, 50 to 75 yr (n = 631)ACR ≥2 mg/mmol in a first-morning spot urine sampleCardiovascular death: RR 3.22 (1.28 to 8.06)All-cause mortality: RR 1.70 (0.86 to 3.34)All-cause mortality in patients with hypertension: RR 2.87 (1.22 to 6.33)
    HUNT (12)Nondiabetic, nonhypertensive residents of Nord-Trøndelag, Norway, ≥20 yr (n = 2089)ACR ≥0.76 mg/mmol (>60th percentile) in a first-morning spot urine sampleAll-cause mortality: RR 2.3 (1.0 to 5.4)
    EPIC-Norfolk (13)Residents of Norfolk, UK, 40 to 79 yr (n = 20,911)ACR 2.5 to 25 mg/mmol in a random spot urine sampleAll-cause mortality: HR 1.48 (1.20 to 1.79)Cardiovascular death: HR 2.03 (1.55 to 2.67)Fatal stroke: HR 1.58 (1.10 to 3.0)Coronary heart disease death: HR 2.01 (1.40 to 2.90)
    EPIC-Norfolk (24)Residents of Norfolk, UK, 40 to 79 yr (n = 23,630)ACR 2.5 to 25 mg/mmol in a random spot urine sampleStroke: HR 1.49 (1.13 to 2.14)
    Third Copenhagen City Heart Study (14)Residents of Copenhagen, Denmark, 30 to 70 yr, without coronary heart diseaseUAE >4.8 μg/min (>3rd quartile) in a timed overnight urine sampleAll-cause mortality: RR 1.9 (1.5 to 2.4)Coronary heart disease: RR 2.0 (1.4 to 3.0)
Danish MONICA (22)Population-based: Individuals without ischemic heart disease, renal disease, urinary tract infection, or diabetes (n = 2085)ACR >0.65 mg/mmol (>90th percentile) in a first-morning spot urine sampleIschemic heart disease: RR 2.3 (1.3 to 3.9)
    Shibata Study (25)Residents of Shibata, Japan, ≥40 yr (n = 2651)Positive albumin dipstick testStroke: RR in men 2.5 (1.1 to 5.7)
Portland Study (26)Older residents of Portland, Oregon, with previous stroke or transient ischemic attack (n = 121)UAE 20 to 200 mg/L in a first-morning spot urine sampleRecurrent stroke: HR 4.9 (1.4 to 17.6)
    Slowik et al. (27)Patients admitted within 24 h of a first ischemic stroke (n = 60)UAE 30 to 300 mg in a 24-h urine sampleMortality: OR 6.0 (1.3 to 27.7)
Cross-sectional studies
    Zander et al. (29)Patients with type 2 diabetes (n = 1060)UAE 20 to 200 μg/min in a timed overnight urine samplePAD: OR 2.1 (1.4 to 3.2)
    PREVEND (20)Nondiabetic residents of Groningen, the Netherlands, 28 to 75 yr (n = 7579)UAE 30 to 300 mg in a 24-h urine sampleElectrocardiographic abnormalities:Infarct patterns: OR 1.61 (1.12 to 2.32)Major ischemia: OR 1.43 (1.08 to 1.91)Minor ischemia: OR 1.32 (1.03 to 1.68)
    PREVEND (28)Nondiabetic residents of Groningen, the Netherlands, 28 to 75 yr (n = 6669)UAE 30 to 300 mg in a 24-h urine samplePAD: OR 0.98 (0.68 to 1.41) in multivariate analysis
    Earle et al. (19)Patients with type 1 diabetes and without CVDUAE 20 to 200 μg/min in a timed overnight urine sampleSilent myocardial ischemia: OR 6.3 (1.2 to 37.8)
  • a ACR, albumin-to-creatinine ratio; CI, confidence interval; CVD, cardiovascular disease; EPIC-Norfolk, European Prospective Investigation into Cancer in Norfolk; HOPE, Heart Outcomes Prevention Evaluation; HR, hazard ratio; HUNT, Nord-Trøndelag Health Study; OR, odds ratio; PAD, peripheral artery disease; PREVEND, Prevention of Renal and Vascular End Stage Disease; RR, relative risk.