Albuminuria, its assessment and management in Australian patients with type 2 diabetes (NEFRON-3)
Objective: To determine the prevalence of albuminuria in patients with type 2 diabetes in the Australian primary care setting and examine the factors that influence its identification and management.
Design, setting and participants: 348 GP investigators provided clinical data from 10-15 consecutively presenting adult patients with established type 2 diabetes.The level of albuminuria, which were systematically compared to ACR provided by GPs themselves and their management strategy.
Results: One in three patients had an elevated urinary ACR, (34.6%, 95% CI, 33.3-35.9%), most of whom had microalbuminuria (27.3%). 7.3% of patients had an ACR in the macroalbuminuric range including 1.6% with proteinuria. GPs classified 31.2% of their patients as having an abnormal ACR, with a sensitivity of 73% and a specificity of 90%. 70.9% of patients with an abnormal ACR were prescribed an agent that blocked the renin angiotensin system (RAS), predominantly with an ACE inhibitor (54%) compared to an angiotensin receptor blocker (34%, including 9% on dual blockade). 66% of patients with normoalbuminuria also received an agent that blocked the RAS (ACE: ARB, 2:1). Despite the increased use of antihypertensives in patients with an abnormal ACR, BP levels were significantly higher and less than 19% achieved recommended BP targets of 130/80 mmHg. However, GPs perceived blood pressure to be optimally controlled in two thirds.
Conclusion: Microalbuminuria is common finding in everyday general practice. However, albuminuria has only a weak effect on the intensity of hypertensive management and RAS blockade.