Albuminuria: Associated With Heart Failure Severity and Impaired Clinical Outcomes

BackgroundUrinary albumin to creatinine ratio (UACR) is common in patients with heart failure (HF) and may have an impact on clinical outcome. We evaluated the effect of UACR on clinical outcome in a real-world cohort of patients with HF.MethodsAll patients with HF at a health maintenance organization were followed for cardiac-related hospitalizations and death.ResultsThe study cohort included 4668 patients with HF and was divided into 3 groups based on UACR: normal-range albuminuria (2085 patients; 45%), microalbuminuria (1769 patients; 38%), and macroalbuminuria (814 patients; 17%). Microalbuminuria and macroalbuminuria were both associated with increasing age, diabetes mellitus, hypertension, peripheral vascular disease, atrial fibrillation, and New York Heart Association class III/IV. Microalbuminuria and macroalbuminuria were directly associated with decreased event-free survival from death and death and cardiovascular hospitalizations. Cox regression analysis after adjustment for significant predictors demonstrated that microalbuminuria was associated with increase in mortality (hazard ratio, 1.18; 95% confidence interval, 1.18-1.38; P = 0.03) and macroalbuminuria (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61; P < 0.001). Albuminuria was also an independent predictor of death and cardiovascular hospitalizations. Analysis of albuminuria as a continuous parameter (natural logarithm transformed) showed that UACR was an independent predictor of mortality, and cardiovascular hospitalizations. Subclinical albuminuria (UACR 12-29 μg/mg) was directly associated with reduced survival. Cox regression analysis using restricted cubic splines demonstrated an independent continuous increase in mortality with increasing albuminuria (P < 0.0001 adjusted linear model).ConclusionAlbuminuria provides important information regarding several detrimental processes in HF and is a significant predictor of a worse outcome.     

Chronic kidney disease and cognitive decline in patients with type 2 diabetes at elevated cardiovascular risk

AimsWe addressed the question whether chronic kidney disease (CKD) may contribute to cognitive decline in type 2 diabetes.MethodsParticipants with type 2 diabetes with elevated cardiovascular risk or CKD from cognition substudies of two large trials were studied prospectively (CARMELINA: n = 2666, mean ± SD age 68.1 ± 8.7 years, CAROLINA: n = 4296; 64.7 ± 9.4 years). Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) at baseline were related to cognitive performance (Mini-Mental State Examination (MMSE) and attention and executive functioning score (A&E)) in linear regression analyses, adjusted for demographics, cardiovascular risk factors and treatment, at baseline and follow-up.ResultsCKD at baseline was more common in CARMELINA than CAROLINA (eGFR<60 in 72.6 % and 19.6 %, macroalbuminuria in 35.0 % and 4.1 %, respectively). Baseline eGFR was related to A&E in CARMELINA (b = 0.02 per 10 ml/min/1.73m², 95%CI [0.01,0.03]). Baseline UACR was related to A&E in CAROLINA (b = ?0.01 per doubling of UACR mg/g, 95%CI [?0.02,?0.002]). Baseline UACR predicted decline in A&E in CAROLINA (median 6.1 years follow-up; b = ?0.01, 95%CI [?0.03,?0.0001] per doubling of UACR mg/g).ConclusionseGFR and UACR were associated with A&E in two cohorts with type 2 diabetes, enriched for CKD and cardiovascular disease. The small effect size estimates indicate limited impact of kidney dysfunction on cognition in this setting.ClinicalTrials.gov identifiersNCT01897532NCT01243424     

Association of Fetuin-A with Thr256Ser exon polymorphism of α2-Heremans Schmid Glycoprotein (AHSG) gene in type 2 diabetic patients with overt nephropathy

BackgroundCirculatory Fetuin-A has been well reported to elevate the risk for Diabetic Nephropathy (DN) and is associated with many vascular complications. Compelling reports have well documented that the circulatory levels of Fetuin-A directly have an impact on its AHSG (α2- Heremans- Schmid Glycoprotein) gene single nucleotide polymorphisms (SNP). Thus, in this study among the South Indian T2DM population, we aim to explore the association of AHSG Thr256Ser (rs4918) SNP in subjects with DN and correlate with the circulatory levels of Fetuin-A at various stages of DN patients.MethodsA total of 975 subjects were recruited, such as Group-I, consisting of Controls (n = 300), Group-II, with normoalbuminuria (n = 300), Group-IIIa, with incipient microalbuminuria (n = 195), Group-IIIb, with persistent macroalbuminuria (n = 180)] and were subjected for genotyping using PCR-Restriction Fragment Length Polymorphism (RFLP). Circulatory Fetuin-A was measured using sandwich enzyme-linked immunosorbent assay (ELISA).ResultsThe ‘G’ allele of AHSG exon-7 (C/G) SNP is significantly concomitant and conferred significant risk for normoalbuminuria subjects. In the DN subjects, the ‘G' allele showed the risk for persistent macroalbuminuria. A noticeable stepwise decrease was evidenced in the circulatory Fetuin-A among persistent macroalbuminuria over incipient microalbuminuria from normoalbuminuria. Further, the circulatory Fetuin-A was lowered in DN subjects with mutant GG genotype than the wild CC.ConclusionAHSG Thr256Ser (rs4918) SNP was associated with renal complications among South Indian T2DM subjects.     

The association between blood oxygen saturation and baroreflex sensitivity in adults with type 1 diabetes with and without albuminuria

BackgroundLow baroreflex sensitivity is an indicator of early cardiovascular autonomic neuropathy. We explored the association between baroreflex sensivity and blood oxygen saturation (SpO₂) in type 1 diabetes and various degrees of microvascular disease.MethodsIn this Danish-Finnish cross-sectional multicentre study, baroreflex sensivity and SpO₂ (pulse oximetry) were examined in persons with type 1 diabetes and normoalbuminuria (n = 98), microalbuminuria (n = 28), or macroalbuminuria (n = 43), and in non-diabetic controls (n = 54). Associations and differences between groups were analysed using regression models and adjustment included age, sex, smoking, HbA_1c, blood haemoglobin, urine albumin creatinine ratio, body mass index, and estimated glomerular filtration rate.ResultsIn type 1 diabetes, higher baroreflex sensitivity was associated with higher SpO₂ before adjustment (% increase per one % increase in SpO₂ = 20 % (95%CI: 11–30); p < 0.001) and the association remained significant after adjustment (p = 0.02). Baroreflex sensitivity was not different between non-diabetic controls and persons with type 1 diabetes and normoalbuminuria (p = 0.052). Compared with type 1 diabetes and normoalbuminuria, baroreflex sensitivity was lower in micro- (p < 0.001) and macroalbuminuria (p < 0.001). SpO₂ was lower in persons with type 1 diabetes and normoalbuminuria compared with non-diabetic controls (p < 0.01). Within the participants with type 1 diabetes, SpO₂ was not different in micro- or macroalbuminuria compared with normoalbuminuria (p-values > 0.05), but lower in macro-compared with microalbuminuria (p < 0.01).ConclusionsLower baroreflex sensitivity was associated with lower SpO₂ in type 1 diabetes. The present study support the hypothesis that hypoxia could be a therapeutic target in persons with type 1 diabetes.     

High Prevalence and Diversity of Kidney Dysfunction in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The BARI 2D Baseline Data

BackgroundWe describe baseline renal function and albumin excretion rate in patients enrolled in Bypass Angioplasty Revascularization Investigation 2 Diabetes, a randomized clinical trial comparing the impact of revascularization and medical therapy with medical therapy alone and deferred or no revascularization and the impact of glycemic control with either insulin-providing or insulin-sensitizing drugs, on 5-year mortality.MethodsStudy participants had type 2 diabetes mellitus, documented coronary artery disease, and creatinine <2 mg/dL. Albuminuria status (albumin/creatinine ratio [ACR]) and estimated glomerular filtration rate (eGFR), using the abbreviated Modified Diet in Renal Disease equation, were determined at baseline. Univariate and multivariate relationships between baseline clinical characteristics and the presence of albuminuria and reduced eGFR rate were estimated.ResultsTwo thousand one hundred forty-six subjects were included in the analysis. Forty-three percent of the cohort had evidence of kidney dysfunction at baseline: 23% had an eGFR ≥60 mL/min/1.73 m² with either microalbuminuria (>30 ACR; 17%) or macroalbuminuria (>300 ACR; 6%). Twenty-one percent had a reduced eGFR <60 mL/min/1.73 m²; 52% with reduced eGFR had no albuminuria; 28% had microalbuminuria, and 20% had macroalbuminuria. Race, smoking status, duration of diabetes, hypertension, hemoglobin A1c, triglycerides, vascular disease, abnormal ejection fraction, and reduced eGFR were associated with greater albuminuria. Age, sex, duration of diabetes, ACR, hemoglobin A1c, high density lipoprotein, and number of hypertensive medications were associated with reduced eGFR.ConclusionKidney dysfunction is common in older patients with type 2 diabetes mellitus and coronary artery disease; Albuminuria was present in 33%. Reduced eGFR was present in 21%, and half the patients with reduced eGFR had no evidence of albuminuria.     

Neutrophil Gelatinase-Associated Lipocalin (NGAL): an early marker for diabetic nephropathy

Neutrophil gelatinase-associated lipoprotein (NGAL) represents a novel biomarker for early identification of acute kidney injury. This study evaluates the usefulness of urine NGAL as a marker for the early detection of diabetic nephropathy. This is a cross-sectional study which involved ninety patients with diabetes mellitus and thirty healthy controls. The diabetic patients were categorized into three groups based on their urine albumin/creatinine ratio (UACR); normoalbuminuria (<3.5?mg/mmol), microalbuminuria (3.5?C35?mg/mmol), macroalbuminuria (>35?mg/mmol). In addition to urine NGAL, HbA1C, serum creatinine, urine albumin/creatinine ratio, serum cystatin C, and urine protein were assessed to determine their correlation with urine NGAL. Data analysis was done by using SPSS and MiniTab. Urine NGAL was elevated in all groups of diabetic patients with respect to controls. It was increased proportionately to the severity of kidney function. It was also elevated in some normoalbuminuria diabetic patients. Analysis of correlation revealed that urine NGAL was not correlated with glycemic indices (HbA1C and fasting blood glucose). However, urine NGAL correlated significantly with cystatin C, serum creatinine, urine albumin/creatinine ratio, and inversely with eGFR. Besides, it is also shown to have a significant correlation with eGFR in advanced kidney disease (eGFR?<?30?ml/min per 1.73?min²). Urine NGAL can be used as a non-invasive tool for the early detection and assessment of the severity of diabetic nephropathy.     

Urinary adiponectin excretion rises with increasing albuminuria in type 1 diabetes

AimUrinary adiponectin (u-adiponectin) excretion has been suggested to reflect early glomerular damage. Inspired by this, we studied the levels of u-adiponectin in type 1 diabetic patients with different levels of urinary albumin excretion (UAE).MethodsU-adiponectin was analysed by ELISA in type 1 diabetic patients: Fifty-eight with normoalbuminuria (< 30 mg albumin/24 h), 43 with persistent microalbuminuria (30–300 mg/24 h) and 44 with persistent macroalbuminuria (> 300 mg/24 h). For comparison, a control group of 55 healthy individuals was included.ResultsU-adiponectin increased with increasing levels of UAE (p < 0.01). U-adiponectin median (interquartile range): Normoalbuminuria 0.38 (0.14–1.31), microalbuminuria 1.12 (0.20–2.68), macroalbuminuria 9.20 (1.10–23.35) and controls 0.09 (0.06–0.24) μg/g creatinine. Levels were unrelated to sex, age, cholesterol, diastolic BP and BMI. U-adiponectin was weakly associated with increasing systolic BP and HbA_1c (r² < 0.1, p < 0.05), but strongly related to increasing UAE (r² = 0.57, p < 0.001) and decreasing eGFR (r² = 0.26, p < 0.001). The relationship between UAE and u-adiponectin was significant in all groups and independent of eGFR, BMI, BP and HbA_1c. Furthermore, u-adiponectin was associated with markers of tubular damage (p < 0.01).ConclusionU-adiponectin rises with increasing levels of UAE in patients with type 1 diabetes. This is in accordance with the hypothesis that loss of adiponectin may reflect glomerular and/or tubular damage.     

Metabolic syndrome and risk of progression of chronic kidney disease: a single-center cohort study in Japan

Metabolic syndrome (MetS) is a risk factor for the development of diabetes and cardiovascular disease, and recently was linked to incident chronic kidney disease (CKD). The purpose of this study is to examine whether MetS is associated with CKD progression in Japanese at a single center. Outcome variables were a decrease in estimated glomerular filtration rate (eGFR) of 50 % or 25 ml/min/1.73 m², end-stage renal disease (ESRD), death, or a composite outcome of all three. There were 213 subjects in the analysis, 40.4 % of whom met the criteria for MetS. The group of subjects with MetS had higher urinary albumin-to-creatinine (UACR) levels. Survival curves stratified by MetS status showed early separation of the curves and a significantly higher survival rate in the group without MetS (P = 0.0086). Comparisons with normoalbuminuria and microalbuminuria showed that macroalbuminuria was equally associated with predicted composite outcome (GFR, ESRD, or death) both in the presence and absence of MetS. Multivariate analyses for all covariates showed that eGFR (hazard ratio (HR) 8.286, 95 % confidence interval (CI) 2.360–28.044, P = 0.0012) and the UACR (HR 2.338, 95 % CI 1.442–3.861, P = 0.0005) at baseline were independently associated with the composite outcomes. The results show that MetS was associated with albuminuria in a cohort of Japanese CKD patients, and both MetS and albuminuria were independently associated with CKD progression.     

Urinary tubular biomarkers in short-term type 2 diabetes mellitus patients: a cross-sectional study

The purpose of this study was to investigate the prevalence of tubular damage in short-term (less than five years) type 2 diabetes mellitus (T2DM) patients and to explore the correlation between tubular markers and their relationship with renal indices at different stages of diabetic nephropathy. A group of 101 short-term T2DM patients and 28 control subjects were recruited. Tubular markers, such as neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D: -glucosaminidase (NAG), and kidney injury molecule 1 (KIM-1), as well as urinary albumin excretion were measured in voided urine. Glomerular filtration rate (GFR) was estimated via Macisaac's formula. The patients were further categorized into three groups, namely, the normoalbuminuria, microalbuminuria, and macroalbuminuria groups, according to their urine albumin/creatinine ratio (UACR). Urinary tubular markers were compared and their correlations with renal indices [UACR and estimated GFR (eGFR)] were analyzed among the different diabetic groups. Compared with the control group, Urinary NGAL [median (IQR)][83.6(41.4-138.7) μg/gcr vs. 32.9(26.1-64.5) μg/gcr], NAG [13.5(8.7-17.9) U/gcr vs. 7.6(6.5-13.0) U/gcr] and KIM-1 [120.0(98.4-139.9) ng/gcr vs. 103.1(86.8-106.2) ng/gcr] in the T2DM were all markedly increased. For all patients, urinary NGAL had stronger positive correlations with UACR than NAG (R = 0.556 vs. 0.305, both P < 0.05). In addition, only urinary NGAL showed a negative correlation with eGFR (R = -0.215, P < 0.05). Urinary KIM-1, however, showed no significant difference among the three T2DM groups and did not correlate with either UACR or eGFR. As UACR increased from the normoalbuminuria to the last macroalbuminuria group, all of the markers increased. However, only the concentrations of NGAL were statistically different among the three diabetic groups. The correlation between the tubular markers and their relationships with the renal indices differed markedly among the three T2DM groups. In conclusion, these results suggest that tubular damage is common in short-term T2DM patients. Urinary NGAL may be a promising early marker for monitoring renal impairment in short-term T2DM patients.     

Reduced GFR and microalbuminuria are independently associated with prevalent cardiovascular disease in Type 2 diabetes: JDDM study 16

Aims We investigated whether a reduced estimated glomerular filtration rate (eGFR) was associated with cardiovascular disease (CVD) prevalence, independent of the effect of microalbuminuria in patients with diabetes. Methods In a multicentre, large‐scale cohort including 3002 Japanese patients with Type 2 diabetes without macroalbuminuria, the relationship of a reduced eGFR and microalbuminuria with CVD was investigated. Results Of those patients, 4.8% had a reduced eGFR and microalbuminuria, 12.7% had a reduced eGFR without microalbuminuria and 18.7% had microalbuminuria but normal eGFR. A reduced eGFR and microalbuminuria were each associated with a doubling of the prevalence of CVD. Compared with patients with no microalbuminuria/normal eGFR [odds ratio (OR) 1.0], the OR for CVD was significantly higher in those with a reduced eGFR without microalbuminuria (OR 1.97) and similarly higher in those with microalbuminuria without a reduced eGFR (OR 1.85). The OR was highest in those with both a reduced eGFR and microalbuminuria (OR 3.97, 95% confidence interval 2.55–6.20). The OR for CVD remained significant after adjustments for age, sex, hypertension, dyslipidaemia, smoking, body mass index, glycated haemoglobin and the duration of diabetes, and remained significant if the cut‐off point for microalbuminuria was set at the median albumin : creatinine ratio (13.7 mg/g creatinine). In patients without microalbuminuria, a reduced eGFR was associated with CVD only in the older and male groups. Conclusion A reduced eGFR and the presence of microalbuminuria were each associated with a near doubling of the prevalence of CVD, independently of traditional CVD risk factors and glycaemic control in patients with Type 2 diabetes.     

Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. Losartan Intervention for Endpoint Reduction

Background Albuminuria, reflecting systemic microvascular damage, and left ventricular (LV) geometric abnormalities have both been shown to predict increased cardiovascular morbidity and mortality. However, the relationship between these markers of cardiovascular damage has not been evaluated in a large hypertensive population. Methods The urine albumin/creatinine ratio (UACR) and echocardiographic measures of LV structure and function were obtained in 833 patients with stage I to III hypertension and LV hypertrophy determined by electrocardiogram (ECG) (Cornell voltage-duration or Sokolow-Lyon voltage criteria) after 14 days of placebo treatment. Results Patients' mean ages were 66 years, 42% were women, 23% had microalbuminuria, and 5% had macroalbuminuria. Patients with eccentric or concentric LV hypertrophy had higher prevalences of microalbuminuria (average 26%-30% vs 9%, P < .001) and macroalbuminuria (6%-7% vs <1%, P < .001). Furthermore, patients with microalbuminuria and macroalbuminuria had a significantly higher LV mass and lower endocardial and midwall fractional shortening. Patients with abnormal diastolic LV filling parameters had a significantly increased prevalence of microalbuminuria. In univariate analyses, UACR correlated positively to LV mass, systolic blood pressure, age (all P < .001) and pulse pressure/stroke volume and negatively to relative wall thickness (both P < .01) and endocardial (P < .05) and midwall shortening (P < .001) but not to diastolic filling parameters. In multiple regression analysis higher UACR was associated with higher LV mass (β = .169, P < .001) independently of older age (β = .095, P < .01), higher systolic pressure (β = .163), black race (β = .186), and diabetes (β = .241, all P < .001). Conclusions In hypertensive patients with ECG LV hypertrophy, abnormal LV geometry and high LV mass are associated with high UACR independent of age, systolic blood pressure, diabetes, and race, suggesting parallel cardiac and microvascular damage. (Am Heart J 2002;143:319-26.)     

Uric acid in-hospital changes predict mortality in patients with acute myocardial infarction

Background and aimsThe prognostic impact of admission uric acid (UA) levels in patients with acute myocardial infarction (AMI) is controversial. We assessed the prognostic role of in-hospital UA changes in patients with AMI.Methods and resultsWe studied 375 consecutive patients (320 males, mean age 62.6 years) with AMI (232 with ST elevation MI) within 12 h of symptoms' onset. UA levels were daily measured throughout hospitalization and their admission and peak values were recorded. End-points were 30-day and 1-year mortality. Mortality rate at 30 days was 7.2% and at 1 year 10.9%. Patients who died within 30 days exhibited higher peak UA (10.24 mg/dl vs. 7.06 mg/dl, p < 0.001) and absolute UA elevation (1.7 mg/dl vs. 0.7 mg/dl, p < 0.001). Optimal values for predicting 30-day mortality were 9.65 mg/dl for peak UA and 2.35 mg/dl for UA elevation. Concerning 1-year mortality, deceased patients had higher peak UA levels (9.71 mg/dl vs. 7 mg/dl, p < 0.001) and absolute UA elevation (1.5 mg/dl vs. 0.6 mg/dl, p < 0.001). Optimal values for predicting 1-year mortality were 9.55 mg/dl for peak UA and 1.1 mg/dl for UA elevation. With Cox regression analysis peak UA (adjHR 1.157, p = 0.030) and UA elevation (adjHR 1.288, p = 0.009) were independent predictors of 30-day mortality. Similarly, peak UA levels (adjHR 1.204, p = 0.001) and UA elevation (adjHR 1.213, p = 0.001) predicted 1-year mortality.ConclusionsIn patients with AMI peak rather than admission UA levels, and absolute in-hospital UA elevation predict both 30-day and 1-year mortality. Serial in-hospital UA measurements add prognostic information in AMI patients.     

Risk of sarcopenia among older persons with Type 2 diabetes mellitus with different status of albuminuria: A dose-responsive association

BackgroundThe association between type 2 diabetes mellitus (T2DM) and sarcopenia has been reported before, but little was known regarding associations between albuminuria status in the development of sarcopenia. This study aimed to explore the associations between albuminuria status and sarcopenia among older patients with T2DM.MethodsThis cross-sectional study recruited T2DM patients aged 65 years and older from the DM shared care center in a regional hospital who were grossly absent from functional impairment. Demographic characteristics were collected and functional assessments were performed for all participants. Urinary albumin-to-creatinine ratio (UACR) was obtained by spot urine exams, whereas UACR ≥ 30 mg/g was defined as microalbuminuria, and UACR > 300 mg/g as macroalbuminuria. Appendicular lean mass (ASM) was measured by the dual X-ray absorptiometry, and the relative appendicular muscle mass (RASM) was calculated as the ASM divided by height square (kg/m²).The definition of sarcopenia was made according to the Asian Working Group for Sarcopenia and muscle quality was defined as handgrip strength (kg) divided by RASM.ResultsOverall, 180 participants (mean age: 72.5±5.3 years, 53.3% males) were enrolled for study. Higher HbA1c levels and poorer renal function were significantly associated with more severe albuminuria status.Besides, sarcopenia and low handgrip strength also showed dose-responsive associations with albuminuria status, which was similar in muscle quality.The receiver operating characteristic curve determine that the UACR of 13.7 mg/g was the optimal cutoff for sarcopenia diagnosis, which was lower than the conventionally definition of microalbuminuria (<30 mg/g).ConclusionsAlbuminuria status was dose-responsively associated with sarcopenia among older persons with T2DM, and the risk started to escalate from minimal albuminuria (UACR 9.18 mg/g in men and 18.4 mg/g in women). Further intervention studies are needed to evaluate potential benefits of better diabetes control in preventing sarcopenia and its outcomes.     

Prevalence of micro- and macroalbuminuria,arterial hypertension,retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients

Summary The prevalence of micro- and macroalbuminuria was determined in Type 2 (non-insulin-dependent) diabetic patients, less than 76 years of age, attending a diabetic clinic during 1987. All eligible patients (n=557) were asked to collect a 24-h urine sample for quantitative albumin analysis. Urine collections were obtained in 296 males and 253 females (96%). Normoalbuminuria were defined as urinary albumin excretion30 mg/24 h (n=323), microalbuminuria as 31–299 mg/24 h (n=151), and macroalbuminuria as 300 mg/ 24 h (n=75). The prevalence of macroalbuminuria was significantly higher in males (20%) than in females (6%), while the prevalence of microalbuminuria was almost identical in males (26%) and females (29%). The prevalence of arterial hypertension increased with increased albuminuria, being 48%, 68%, and 85% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of proliferative retinopathy rose with increasing albuminuria, being 2%, 5% and 12% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of coronary heart disease, based on Minnesota coded electrocardiograms, was more frequent in patients with macroalbuminuria (46%) compared to patients with microalbuminuria (26%) and patients with normoalbuminuria (22%). Foot ulcers were more frequent in micro- and macroalbuminuric patients, being 13% and 25%, respectively, compared to 5% in patients with normoalbuminuria. This cross-sectional study has revealed a high prevalence of microalbuminuria (27%) and macroalbuminuria (14%) in Type 2 diabetic patients. Patients with raised urinary albumin excretion are characterized by obesity, elevated haemoglobin A_lc, increased frequency of arterial hypertension, proliferative retinopathy, coronary heart disease and foot ulcers. Thus, these findings suggest that urinary excretion of albumin should be monitored routinely in patients with Type 2 diabetes.     

尿白蛋白正常的2型糖尿病患者肾功能下降的影响因素

目的 探讨24 h尿白蛋白排泄率正常的2型糖尿病患者估算的肾小球滤过率(eGFR)及其主要的影响因素.方法 采用中华医学会糖尿病学分会对住院糖尿病患者慢性并发症调查的资料,以改良的肾脏病膳食改良试验(MDRD)公式计算eGFR并进行分析.结果 正常白蛋白尿、微量白蛋白尿和大量白蛋白尿患者中分别有19.7%(149/755)、21.9%(102/466)和45.4%(59/130)出现eGFR的下降.正常白蛋白尿患者中eGFR下降组慢性并发症的发生率较eGFR正常组高.多因素logistic回归分析显示,年龄(OR=1.042,P<0.001)、糖尿病病程(OR=1.038,P=0.045)和收缩压(OR=1.017,P<0.001)是影响eGFR的主要因素,BMI(OR=0.868)及糖化血红蛋白(OR=0.898)亦与eGFR的下降有关.结论 尿白蛋白正常的2型糖尿病患者已有部分出现肾功能损害,结合eGFR有助于更好地评价2型糖尿病患者的肾脏损害情况.     

Systolic blood pressure as a predictor of incident albuminuria and rapid renal function decline in type 2 diabetic patients

AimsAlbuminuria and a reduced estimated glomerular filtration rate (eGFR) are known risk factors of poor cardiovascular outcomes in diabetic patients. We here aimed to investigate the determinants of incident albuminuria and rapid progression of renal dysfunction in patients with type 2 diabetes.MethodsType 2 diabetic outpatients (n = 215) with a mean baseline eGFR of 87 ± 20 mL min^− 1 1.73 m^− 2 were followed for 12 months. Urinary albuminuria was defined according to the urine albumin-to-creatinine ratio (UACR).ResultsAmong 132 patients with normoalbuminuria at baseline, 20 (15.2%) progressed to a more advanced stage of albuminuria within 1 year, and 20.5% of the 215 patients experienced a rapid decline in eGFR (eGFR reduction > 5 mL min^− 1 1.73 m^− 2 year^− 1). After adjusting for potential confounders, both baseline UACR and systolic blood pressure (SBP) were found to be significant independent factors for incident albuminuria and a rapid decline of eGFR in separate models. Using receiver operating characteristic curves, systolic blood pressures of 132 and 138 mmHg were found to predict incident albuminuria and a rapid decline of eGFR, respectively.ConclusionsIn addition to baseline UACR, SBP is one of the most powerful modifiable independent risk factors for incident albuminuria and a rapid renal function decline in type 2 diabetic patients without symptomatic cardiovascular disease.     

Early changes in serum creatinine level and estimated glomerular filtration rate predict pancreatic necrosis and mortality in acute pancreatitis: Creatinine and eGFR in acute pancreatitis

AimThe aim of the study was to evaluate the significance of serum creatinine level (SCL) and estimated glomerular filtration rate (eGFR) measured in an early phase of acute pancreatitis (AP) for prediction of pancreatic necrosis (PNec) and mortality.MethodsOne hundred and forty-seven patients with AP were retrospectively reviewed in the study. Serum creatinine level and estimated glomerular filtration rate (calculated using the abbreviated Modification of Diet in Renal Disease equation) on admission and 48 h thereafter were analyzed for each patient. These parameters were compared with contrast-enhanced computed tomography images performed within 96 h from admission (n = 103). Usefulness of SCL and eGFR for prediction of PNec and fatal outcome of AP was evaluated using a receiver operator characteristic curve analysis and comparison of average parameter values.ResultsWe confirmed pancreatic necrosis in 41 (39.8%) of 103 patients using computed tomography examination. Both creatinine and estimated glomerular filtration rate measured on admission (p < 0.001, p < 0.001 respectively) and 48 h later (p = 0.001, p < 0.001 respectively) were significantly associated with the presence of pancreatic necrosis.Moreover, serum creatinine level and eGFR measured on the 1st day proved to be a good predictor of fatal outcome. Both, mortality and presence of pancreatic necrosis were significantly higher in the group with elevated serum creatinine level and low eGFR values.ConclusionsSCL and eGFR on admission are useful indicators of PNec and mortality.     

Impaired fasting blood glucose is associated with incident albuminuria: Data from a Chinese community-based cohort

ObjectiveGrowing evidence links hyperglycemia in the diabetic range to albuminuria, while the association between impaired fasting glucose (IFG) and albuminuria is not well established. The study intends to explore whether IFG is longitudinally associated with incident albuminuria in a non-diabetic Chinese community-based cohort.MethodsParticipants with urine albumin creatinine ratio (UACR) both in 2014 and 2018 from the atherosclerotic cohort were included. A total of 1649 non-diabetic subjects were ultimately included in the analysis after ruling out participants with UACR≥30 mg/g and self-reported history of renal diseases at baseline. Fasting blood glucose (FBG) was assessed by Roche C8000 Automatic Analyzer and UACR was measured with Unicel DxC 800 Synchron biochemistry analyzer using spot morning urine sample. Incident albuminuria was defined as an advance from normal to microalbuminuria or macroalbuminuria. Multivariable logistic regression model was used to investigate the relationship between FBG and incident albuminuria.ResultsDuring a mean follow-up of 4.38 years, 82 (4.97%) participants developed incident albuminuria. Logistic regression analysis showed that after adjustment, the risk of incident albuminuria increased by 71% (OR = 1.71, 95%CI: 1.11–2.62, P = 0.014) for every 18 mg/dl (1 mmol/l) increase of FBG level. Besides, FBG level was independently and gradably associated with incident albuminuria. Compared with the FBG < 100 mg/dl (5.6 mmol/l) group, the risk increased 1.63-fold for incident albuminuria (OR = 2.63, 95%CI:1.42–4.87, P = 0.002) in the FBG 110-126 mg/dl (6.1–7.0 mmol/l) group while the association between FBG 100-110 mg/dl (5.6–6.1 mmol/l) group and the outcome was not significant. Subgroup and interaction analyses were performed and no significant modification effect was found.ConclusionIFG was independently associated with incident albuminuria in Chinese community-based population. The higher the FBG level, the higher the risk of incident albuminuria, which may suggest that screening for albuminuria should be emphasized in population with IFG so as to prevent and treat it in an early stage.     

Adiponectin, total antioxidant status, and urine albumin excretion in the low-risk “Golden Years” type 1 diabetes mellitus cohort

Adiponectin is associated with inflammation and oxidative stress. Levels are reduced in type 2 diabetes mellitus and coronary heart disease. Conversely, levels are elevated in type 1 diabetes mellitus (T1DM) and associated with microalbuminuria and diabetic nephropathy. An explanation may be that elevated adiponectin in T1DM represents a beneficial counterregulatory response to disease. Our aim was to examine adiponectin in relation to urinary albumin excretion and plasma total antioxidant status (TAOS) in subjects with long-standing T1DM. Serum adiponectin and plasma TAOS were measured in 338 samples from the Golden Years cohort. These subjects have T1DM for at least 50 years and are at low risk of complications. Subjects were divided into normoalbuminuria, microalbuminuria, and macroalbuminuria groups. Adiponectin was elevated in women (20.53 ± 5.94 vs 11.8 ± 3.6 mg/L, P < .001); therefore, the samples were sex stratified. Within men, adiponectin was higher in those with macroalbuminuria (normoalbuminuria vs microalbuminuria vs macroalbuminuria: 10.97 ± 3.26 vs 11.55 ± 3.50 vs 23.63 ± 7.07 mg/L, P = .002). In women, no difference was observed (20.48 ± 5.61 vs 20.75 ± 7.04 vs 29.62 ± 7.81 mg/L, respectively; P = .42). Plasma TAOS did not differ by groups. The correlation between adiponectin and TAOS showed a linear increase from normoalbuminuria, microalbuminuria, to macroalbuminuria in men (r = 0.33, P = .001; r = 0.48, P < .001; r = 0.59, P = .04) and women (r = 0.25, P = .01; r = 0.63, P < .001; r = 0.79, P = .08). Adiponectin was higher in women. Within men, levels were significantly higher in the presence of macroalbuminuria. In both sexes, adiponectin and TAOS were correlated, which was most marked with micro-/macroalbuminuria. The increase in adiponectin in the face of an insult may be a compensatory mechanism to reduce oxidative burden.     

The association between estimated glomerular filtration rate,albuminuria, and risk of cardiovascular hospitalizations and all-cause mortality among patients with type 2 diabetes

Aims

We evaluated the simultaneous effects of all clinically recognized categories of albuminuria and estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) and mortality