Abstract
Objective Although hypoalbuminemia is frequently found in most patients with diabetic nephropathy (DN), its relationship to the severity and progression of DN remains largely unknown. Our aim was to investigate the association between the serum albumin levels and clinicopathological features and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DN. Materials and Methods A total of 188 patients with T2DM and biopsy-proven DN followed up for at least one year were enrolled. The patients were divided into four groups based on the albumin levels: normal group: ≥35 g/L (n = 87); mild group: 30-35 g/L (n = 34); moderate group: 25-30 g/L (n = 36); and severe group: <25 g/L (n = 31). The renal outcome was defined by progression to end-stage renal disease. The impact of the serum albumin level on renal survival was estimated using Cox regression analysis. Results Among the cases, the serum albumin level had a significant correlation with proteinuria, renal function, and glomerular lesions. A multivariate Cox regression analysis indicated that the severity of hypoalbuminemia remained significantly associated with an adverse renal outcome, independent of clinical and histopathological features. In reference to the normal group, the risk of progression to ESRD increased such that the hazard ratio (HR) for the mild group was 2.09 (95% CI, 0.67-6.56, p = 0.205), 6.20 (95% CI, 1.95-19.76, p = 0.002) for the moderate group, and 7.37 (95% CI, 1.24-43.83, p = 0.028) for the severe group. Conclusions These findings suggested that hypoalbuminemia was associated with a poorer renal prognosis in patients with T2DM and DN.
Highlights
Diabetic nephropathy (DN), recently named as diabetic kidney disease (DKD), is one of the most common diabetic microvascular complications and has become the leading cause of chronic kidney diseases in the world [1, 2]
We aimed to investigate the relationship between serum albumin levels and the baseline clinicopathological features in 188 patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DN and to further evaluate the prognostic utility of serum albumin levels
We investigated the relationship between the serum albumin levels and clinicopathological features and renal outcomes in 188 patients with T2DM and biopsyproven DN
Summary
Diabetic nephropathy (DN), recently named as diabetic kidney disease (DKD), is one of the most common diabetic microvascular complications and has become the leading cause of chronic kidney diseases in the world [1, 2]. DN develops in approximately 40% of type 2 diabetic (T2D) patients [3] and nearly 20% of whom will progress to end-stage renal disease (ESRD) [4]. Searching further insight into the pathogenesis and risk factors for DN development is extremely urgent and essential to advance clinical management of DN. The clinical characteristics of DN have traditionally been described as glomerular hyperfiltration, persistent albuminuria, hypertension, and progression to renal failure. A large body of studies has established the contribution of several factors such as severity of glomerular lesions and proteinuria in the progression of DN [8,9,10,11], the number of researches about the association between the serum albumin and biopsy-proven DN was very limited
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