Variability in the urinary albumin-to-creatinine ratio predicts mortality in patients with type 2 diabetes

To investigate the effects of variability in urinary albumin-to-creatinine ratio (UACR) on mortality in patients with type 2 diabetes mellitus (T2DM).

This retrospective cohort study included 3536 patients with T2DM. The annual UACR data were collected not only in the index year but also within two years before the index year to calculate standard deviation (SD). The primary endpoint was all-cause mortality, which was identified by the National Death Registry files from the Ministry of Health and Welfare in Taiwan.

During a median follow-up of 49.3 months, 242 (6.8 %) patients died. Among patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m², those in the increased UACR with high SD group had the highest hazard ratio (HR) for mortality (3.686; 95 % confidence interval [CI]: 2.116-6.421) compared with those in the normal UACR with low SD group. Similarly, among patients with an eGFR <60 mL/min/1.73m², those in the increased UACR with high SD group had the highest HR for mortality (3.404; 95 % CI: 1.361-8.511) compared with those in the normal UACR with low SD group.

UACR variability and increased UACR have a synergistic effect on mortality prediction in patients with T2DM.