Abstract
Introduction: The occurrence of microalbuminuria in type 2 diabetes mellitus (T2DM) patients is regarded as an early clinical sign of incipient kidney damage. Microalbuminuria is often evaluated as urinary albumin to urinary creatinine ratio (ACR). Aim: To assess determinants of microalbuminuria in T2DM patients without prior diagnosis of nephropathy using ACR cut-off values. Materials and Methods: ACR was measured in a total of 90 T2DM patients, during two months in three non-consecutive days, and routine biochemical analyses were performed, including glycated hemoglobin (HbA1c), serum uric acid (SUA), and atherogenic index of plasma (AIP). The cut-off values of ACR were ≤ 2.5 mg/mmol in males, and ≤ 3.5 mg/mmol in females. Duration of T2DM, history of hypertension, HbA1c, estimated glomerular filtration rate (eGFR), AIP, and SUA were investigated for association with microalbuminuria. Results: According to ACR patients were considered as non-albuminuric (n= 57) and microalbuminuric (n = 33). Compared to non-albuminuric group, microalbuminuric group had increased urinary creatinine, urinary albumin, HbA1c, triglycerides and SUA, whilst decreased HDL-cholesterol levels. Although eGFR was generally reduced, the correlation between LogACR and eGFR was not significant (p > 0.05). However, the correlation between LogACR and LogHbA1c was significant. The multiple logistic regression analysis revealed HbA1c (t = 3.42; p = 0.012) and SUA (t = 2.44; p = 0.040) as independent predictors of microalbuminuria in T2DM patients. Conclusion: At ACR cut-off values, concentrations of HbA1c and SUA were independent predictors of microalbuminuria in T2DM patients not yet diagnosed with nephropathy.
Highlights
Diabetic nephropathy (DN) is a relatively frequent microvascular complication of chronic hyperglycemia in type 2 diabetes mellitus (T2DM) patients, characterized by progressive fall of glomerular filtration rate (GFR), hypertension and persistent proteinuria, mainly albuminuria [1, 2]
Given that determinants of microalbuminuria may help identifying risk factors for diabetic kidney disease, this study has investigated the relationship between albumin to urinary creatinine concentration ratio (ACR) and several demographical, biochemical and clinical parameters in patients withT2DM
ACR values were measured in a total of 90 patients with T2DM without previous diagnosis of DN
Summary
Diabetic nephropathy (DN) is a relatively frequent microvascular complication of chronic hyperglycemia in type 2 diabetes mellitus (T2DM) patients, characterized by progressive fall of glomerular filtration rate (GFR), hypertension and persistent proteinuria, mainly albuminuria [1, 2]. Even a minimally increased urinary albumin excretion is regarded as an early sign of incipient kidney damage, with potential to progress to overt renal disease. Given that DN is highly prevalent in both developed and developing countries and is still rising among end-stage renal disease patients [3, 4], assessment of urinary albumin excretion rate and recognition of associated risk factors of diabetic kidney damage are of great importance. The most clinicians prefer to assess kidney function as estimated GFR (eGFR), a mathematical approximation usually calulated by Modification of Diet in Renal Disease (MDRD) study group formula, which includes data regarding age, sex, ethnicity, and serum creatinine. Serum creatinine levels can be unchanged untill even 50% of kidney function is lost, eGFR may not always reliably reflect the degree of kidney damage [7]
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