Albuminuria predicting outcome in diabetes: incidence of microalbuminuria in Asia-Pacific Rim.

Microalbuminuria is not an unusual finding in the general population, even in individuals without diabetes, hypertension, or cardiovascular risk factors. Prevalence studies in the United States, such as NHANES III, reported an overall incidence of microalbuminuria in 22,244 patients, with and without diabetes, of 7.8%. In those individuals with diabetes, the prevalence was 28.8%. Even in patients without diabetes, cardiovascular disease, or abnormal serum creatinine levels, the prevalence of microalbuminuria was still 5.1%. Similarly, a large Dutch study of 41,000 participants demonstrated a 7% incidence of microalbuminuria. In those individuals with diabetes, the microalbuminuria rate was 16%. Thus, in both the United States and Europe, prevalence studies indicate that microalbuminuria is not uncommon. In southeast Asia and the western Pacific, the incidence of type 2 diabetes is rapidly escalating. It is expected that by 2025 the major prevalence of type 2 diabetes in the world will not be in North America or Europe but in Asia-Pacific Rim. Consequently, there is great interest in evaluating the incidence of microalbuminuria in this region. In the Microalbuminuria Prevalence Study (MAPS) the prevalence of macroalbuminuria was noted to be 18.8% and microalbuminuria 39.8% in a total of 6800 hypertensive diabetic adult patients from 10 Asian countries. Thus, there is important evidence that the substantial prevalence of microalbuminuria and macroalbuminuria in the Pacific region indicates an impending pandemic of diabetic cardiovascular and renal disease.