Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice
ABSTRACT INTRODUCTIONMacroalbuminuria in people with type 2 diabetes is common among Pasifika peoples and is associated with end-stage kidney disease and major cardiovascular disease. AIMIn a primary care practice catering for Pasifika people, to determine the time after first recognition of macroal...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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CSIRO Publishing
2021-01-01
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| Series: | Journal of Primary Health Care |
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| Online Access: | https://www.publish.csiro.au/hc/pdf/HC21010 |
| _version_ | 1797979847643889664 |
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| author | Tim Cundy Glenn Doherty Fifita McCready Tian Cooke |
| author_facet | Tim Cundy Glenn Doherty Fifita McCready Tian Cooke |
| author_sort | Tim Cundy |
| collection | DOAJ |
| description | ABSTRACT
INTRODUCTIONMacroalbuminuria in people with type 2 diabetes is common among Pasifika peoples and is associated with end-stage kidney disease and major cardiovascular disease.
AIMIn a primary care practice catering for Pasifika people, to determine the time after first recognition of macroalbuminuria to the occurrence of major cardiovascular and renal events, and to examine the relationship with retinopathy status.
METHODSIn a retrospective observational cohort study, we documented the occurrence of major cardiovascular events and amputations, end-stage kidney disease and death in 115 people with type 2 diabetes reviewed by a specialist diabetes physician at the Langimalie Tongan Health practice between 2005 and 2018. The follow up was 1–19 (median 9.5) years from the first recognition of macroalbuminuria (albumin:creatinine ratio of >30g/mol). Survival was described by using Kaplan–Meier analysis.
RESULTSMacroalbuminuria was detected a mean of 9 years after the diagnosis of diabetes, at a mean age of 52 (standard deviation 12) years. Within 6 years of macroalbuminuria detection, 4% of people had died, 15% had reached end-stage kidney disease, 15% had cardiovascular events or amputations and 30% had the composite outcome of any of these. Within 12 years, the respective proportions were: 24%, 29%, 20% and 48%. The composite outcome was less frequent (P<0.002) in patients without retinopathy at the time macroalbuminuria was recognised. Compared to patients with retinopathy, this group were younger (P=0.025), more obese (P<0.0001), had better baseline renal function (P=0.018) and a shorter interval between the diagnosis of diabetes and recognition of macroalbuminuria (P<0.0001).
DISCUSSIONIn this Pasifika population, macroalbuminuria was a marker for serious adverse cardiovascular and renal disease, and mortality, but in the 29% of patients without retinopathy at the time of recognition of macroalbuminuria, the natural history was more benign. The management of such comorbid patients is a substantial challenge for primary health-care services. |
| first_indexed | 2024-04-11T05:45:12Z |
| format | Article |
| id | doaj.art-070eb15c6a724d9fa3b77190b892d58b |
| institution | Directory Open Access Journal |
| issn | 1172-6156 |
| language | English |
| last_indexed | 2024-04-11T05:45:12Z |
| publishDate | 2021-01-01 |
| publisher | CSIRO Publishing |
| record_format | Article |
| series | Journal of Primary Health Care |
| spelling | doaj.art-070eb15c6a724d9fa3b77190b892d58b2022-12-22T04:42:14ZengCSIRO PublishingJournal of Primary Health Care1172-61562021-01-01132132138HC21010Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practiceTim Cundy0Glenn Doherty1Fifita McCready2Tian Cooke3Langimalie Tongan Health, Onehunga, Auckland, New Zealand; and Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand; and Corresponding author. Email: tcundy@adhb.govt.nz; t.cundy@auckland.ac.nzLangimalie Tongan Health, Onehunga, Auckland, New Zealand.Langimalie Tongan Health, Onehunga, Auckland, New Zealand.Langimalie Tongan Health, Onehunga, Auckland, New Zealand; and Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.ABSTRACT INTRODUCTIONMacroalbuminuria in people with type 2 diabetes is common among Pasifika peoples and is associated with end-stage kidney disease and major cardiovascular disease. AIMIn a primary care practice catering for Pasifika people, to determine the time after first recognition of macroalbuminuria to the occurrence of major cardiovascular and renal events, and to examine the relationship with retinopathy status. METHODSIn a retrospective observational cohort study, we documented the occurrence of major cardiovascular events and amputations, end-stage kidney disease and death in 115 people with type 2 diabetes reviewed by a specialist diabetes physician at the Langimalie Tongan Health practice between 2005 and 2018. The follow up was 1–19 (median 9.5) years from the first recognition of macroalbuminuria (albumin:creatinine ratio of >30g/mol). Survival was described by using Kaplan–Meier analysis. RESULTSMacroalbuminuria was detected a mean of 9 years after the diagnosis of diabetes, at a mean age of 52 (standard deviation 12) years. Within 6 years of macroalbuminuria detection, 4% of people had died, 15% had reached end-stage kidney disease, 15% had cardiovascular events or amputations and 30% had the composite outcome of any of these. Within 12 years, the respective proportions were: 24%, 29%, 20% and 48%. The composite outcome was less frequent (P<0.002) in patients without retinopathy at the time macroalbuminuria was recognised. Compared to patients with retinopathy, this group were younger (P=0.025), more obese (P<0.0001), had better baseline renal function (P=0.018) and a shorter interval between the diagnosis of diabetes and recognition of macroalbuminuria (P<0.0001). DISCUSSIONIn this Pasifika population, macroalbuminuria was a marker for serious adverse cardiovascular and renal disease, and mortality, but in the 29% of patients without retinopathy at the time of recognition of macroalbuminuria, the natural history was more benign. The management of such comorbid patients is a substantial challenge for primary health-care services.https://www.publish.csiro.au/hc/pdf/HC21010Cardiovascular diseaserenal failuremacroalbuminuriaretinopathytype 2 diabetes |
| spellingShingle | Tim Cundy Glenn Doherty Fifita McCready Tian Cooke Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice Journal of Primary Health Care Cardiovascular disease renal failure macroalbuminuria retinopathy type 2 diabetes |
| title | Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice |
| title_full | Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice |
| title_fullStr | Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice |
| title_full_unstemmed | Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice |
| title_short | Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice |
| title_sort | morbidity and mortality after recognition of macroalbuminuria in pasifika people with type 2 diabetes in a primary health care practice |
| topic | Cardiovascular disease renal failure macroalbuminuria retinopathy type 2 diabetes |
| url | https://www.publish.csiro.au/hc/pdf/HC21010 |
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