Can both normal and mildly abnormal albuminuria and glomerular filtration rate be a danger signal for diabetic peripheral neuropathy in type 2 diabetes mellitus?

Abstract

We aimed to investigate the potential association between urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) and diabetic peripheral neuropathy (DPN). We were especially interested in the relationship between normal or mildly abnormal UACR and eGFR with DPN. A retrospective study was performed in 1059 patients with type 2 diabetes patients from Fuzhou, China, who were seen between 2010 and 2015. The DPN population demonstrated higher UACR and lower eGFR than the non-DPN population. Nerve conduction velocities (NCVs) were negatively correlated with UACR and were positively correlated with eGFR. UACR and eGFR were associated with the risk of DPN. Even in the UACR<30mg/g and eGFR≥60ml/min/1.73m2 groups, the relationship above still existed and patients in the highest tertiles of UACR and lowest tertiles of eGFR demonstrated a greater risk of DPN (OR=2.456, 95% CI 1.461-4.127; OR=2.021, 95% CI 1.276-3.203). Receiver operating characteristic (ROC) analysis revealed that the area under curve (AUC) of UACR, eGFR, and joints indicates that DPN was 0.749, 0.662, and 0.731, respectively. Lower eGFR and higher UACR may be associated with the risk of DPN, even though normal or mildly abnormal UACR and eGFR have already been found to be predictive factors of DPN. Further, UACR is more sensitive than eGFR. Separately, UACR was a moderate indication of DPN, and combining it with eGFR did not increase its effect of indication to DPN.