Single and joint impact of type 2 diabetes and of congestive heart failure on albuminuria

Abstract

Albuminuria is a characteristic feature of diabetic nephropathy, and urine albumin excretion is also increased in patients with congestive heart failure (CHF). However, no data are available on the single and joint associations of type 2 diabetes mellitus (T2DM) and CHF with albuminuria. This issue was addressed in the present study. We investigated 4 groups of patients: 180 patients with CHF, of whom 83 had T2DM (CHF+/T2DM+) and 97 did not have diabetes (CHF+/T2DM-) and 223 controls without CHF, of whom 39 had T2DM (CHF-/T2DM+) and 184 did not have diabetes (CHF-/T2DM-). The albumin-creatinine ratio (ACR) was 9.2 [5.7-16.9] mg/g in CHF-/T2DM- patients. Compared to this group it was higher in CHF-/T2DM+ patients (16.1 [7.7-27.8] mg/g; p=0.004), in CHF+/T2DM- patients (22.0 [9.0-76.8] mg/g; p<0.001) and in CHF+/T2DM+ patients (66.2 [16.0-177.0] mg/g; p<0.001), in whom in turn it was higher than in CHF-/T2DM+ (p<0.001) or in CHF+/T2DM- (p=0.001) patients. The ACR did not differ significantly between CHF-/T2DM+ and CHF+/T2DM- patients (p=0.188). In multivariate analysis of covariance, CHF and T2DM proved to be independent predictors of ACR after multivariate adjustment (F=5.68; p=0.018 and F=4.79; p=0.029, respectively). We conclude that T2DM and CHF are mutually independent determinants of albuminuria.