Association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus

Jiteshri Mehta,Kedar G Mehta,Varsha Y Godbole,A Lalithambigai

doi:10.1186/s43162-021-00057-w

Abstract

BackgroundThe prevalence of diabetes mellitus is on rising trend in developing countries like India. In type 2 diabetes patients, albuminuria has been shown to predict development of dysfunction in other organ systems such as kidneys, nervous system, and retina and increase risk of cardiovascular (CV) morbidity and mortality. In this study, we plan to assess association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus.ResultsThis cross-sectional study was conducted among 100 type 2 diabetes mellitus patients attending a tertiary care hospital in Gujarat, Western India. Based on urine albumin excretion status, they were divided in two groups of 50 each—normoalbuminuric and microalbuminuric patients. The mean FBS, PPBS, and HbA1c level was significantly lower in normoalbuminuric group compared to microalbuminuric group. There was an increase in cholesterol, triglyceride, VLDL, and LDL levels and decrease in HDL levels in microalbuminuric group as compared to normoalbuminuric group. Multivariate logistic regression analysis revealed that increase in age and a decrease in E/A ratio in patients with microalbuminuria was significantly associated with left ventricular diastolic dysfunction (LVDD).ConclusionThe presence of microalbuminuria is associated with increased likelihood of LVDD in type 2 diabetes patients. Increase in age and decrease in E/A ratio show direct and independent association with LVDD in normotensive diabetic patients with microalbuminuria. Therefore, diabetes patients who have microalbuminuria should be regularly (or more frequently) evaluated for development of LVDD using Echocardiography. This can allow early identification of myocardial diastolic dysfunction.

Highlights

The prevalence of diabetes mellitus is on rising trend in developing countries like India
The mean fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and Glycosylated hemoglobin (HbA1c) levels were significantly lower in normoalbuminuric group compared to microalbuminuric group
The mean creatinine level was comparable between normoalbuminuric group and microalbuminuric group while mean Estimated glomerular filtration rate (eGFR) was significantly higher and mean urine albumin-to-creatinine ratio (UACR) was significantly lower in normoalbuminuric group compared to microalbuminuric group

Summary

Introduction

The prevalence of diabetes mellitus is on rising trend in developing countries like India. In type 2 diabetes patients, albuminuria has been shown to predict development of dysfunction in other organ systems such as kidneys, nervous system, and retina and increase risk of cardiovascular (CV) morbidity and mortality. We plan to assess association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus. Scientific studies from various parts of India have reported the rising prevalence of lifestyle-related diseases. Patients with diabetes who are at increased risk of Diabetic Kidney Disease (DKD) include those with poor glycemic control, longer duration of diabetes, hypertension, retinopathy, raised proteinuria levels, non-White race, family history of hypertension, and cardiovascular diseases (CVDs) [3]. The prevalence of microalbuminuria in hypertensive and diabetic populations varies from 10 to 40%.

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