Abstract
BackgroundAlbuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression. The aim of this study was to evaluate the use of nonalbumin proteinuria in addition to albuminuria for predicting the progression of type 2 diabetic nephropathy.MethodsIn this retrospective observational study, the urine albumin-to-creatinine ratio (ACR) and the nonalbumin protein-to-creatinine ratio (NAPCR) were measured in 325 patients with type 2 diabetes and estimated glomerular filtration rates (eGFR) ≥30 mL/min/1.73 m2. The patients were divided into four groups based on the cutoff points for the urinary ACR (30 mg/g) and NAPCR (120 mg/g). The renal outcomes were chronic kidney disease (CKD) progression and accelerated eGFR decline.ResultsDuring the 4.3-year follow-up period, 25 (7.7%) patients showed CKD progression and 69 (21.2%) patients showed accelerated eGFR decline. After adjusting for nine clinical parameters, the group with a NAPCR greater than 120 mg/g exhibited higher cumulative incidences of CKD progression (hazard ratio 6.84; P = 0.001) and accelerated eGFR decline (hazard ratio 1.95; P = 0.011) than the group with a NAPCR < 120 mg/g. In patients with normoalbuminuria, the group with NAPCR levels greater than 120 mg/g also exhibited a higher cumulative incidence than that with NAPCR levels <120 mg/g of CKD progression (hazard ratio 21.82; P = 0.005). The addition of NAPCR to ACR improved the model fit for CKD progression and accelerated eGFR decline.ConclusionNonalbumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type 2 diabetes.
Highlights
Albuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression
The patients were categorized into four groups according to the cutoff points of urinary albumin-to-creatinine ratio (ACR) (30 mg/g) and nonalbumin protein-to-creatinine ratio (NAPCR) (120 mg/g): 146 patients with normoalbuminuria and NAPCR levels below the cutoff point (
Diabetic retinopathy was more frequently observed and more renin–angiotensin system (RAS) inhibitors were administered in the albuminuria group than in the normoalbuminuria group
Summary
Albuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression. The aim of this study was to evaluate the use of nonalbumin proteinuria in addition to albuminuria for predicting the progression of type 2 diabetic nephropathy. Diagnosis of patients at risk for the progression of diabetic nephropathy may reduce the global burden of type 2 diabetes. If protein loss to the urine is normal, albumin is considered to be a minor component of the total protein released into urine [7]. It is questionable whether albuminuria alone exhibits useful diagnostic and prognostic power because NAP encompasses various urinary biomarkers and may reflect multiple
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