Abstract
Albuminuria and reduced glomerular filtration rate have a great impact on the progression of end-stage renal disease and cardiovascular events. The purpose of the study was to determine the clinical factors associated with different combined albuminuria and glomerular filtration rate among patients with type 2 diabetes. A total of 361 consecutive outpatients who attended the department of endocrinology and metabolism were retrospectively recruited in this cross-sectional study. Urinary albuminuria-creatinine ratio and estimated glomerular filtration rate were applied to designate different renal stages. Polytomous logistic regression was then performed to assess the associated clinical factors among these different renal stages. The proportion of subjects with normoalbuminuria with low glomerular filtration rate was 8.3 % in all study patients. We demonstrated that associated factors of different combined albuminuria and estimated glomerular filtration rate stages were quite distinct, and correlate factors for normoalbuminuria with low glomerular filtration rate were older age (p < 0.001), longer duration of diabetes (p = 0.009), and more statin/fibrate use (odd ratio [95 % confidence interval]: 4.37 [1.45–13.18]; p = 0.009). The associated factors among different combined albuminuria and estimated glomerular filtration rate stages were distinct. Whether early modification of these related factors can prevent or delay the progression of kidney disease warrants further investigations.
Similar content being viewed by others
References
Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Herzog C, et al. US renal data system 2012 annual data report. Am J Kidney Dis. 2013;61:1–476.
Wu MS, Wu IW, Shih CP, Hsu KH. Establishing a platform for battling end-stage renal disease and continuing quality improvement in dialysis therapy in Taiwan–Taiwan renal registry data system (TWRDS). Acta Nephrologica. 2011;25:148–53.
Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med. 1984;310:356–60.
Kramer CK, Leitão CB, Pinto LC, Silveiro SP, Gross JL, Canani LH. Clinical and laboratory profile of patients with type 2 diabetes with low glomerular filtration rate and normoalbuminuria. Diabetes Care. 2007;30:1988–2000.
Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. Risk factors for renal dysfunction in type 2 diabetes: U.K. prospective diabetes study 74. Diabetes. 2006;55:1832–9.
Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003;289:3273–7.
Rossing P, Hougaard P, Parving HH. Progression of microalbuminuria in type 1 diabetes: 10-year prospective observational study. Kidney Int. 2005;68:1446–50.
Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int. 2011;80:17–28.
Taal MW, Brenner BM. Predicting initiation and progression of chronic kidney disease: developing renal risk scores. Kidney Int. 2006;70:1694–705.
Yokoyama H, Sone H, Oishi M, Kawai K, Fukumoto Y, Kobayashi M. Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant. 2009;24:1212–9.
Jia W, Gao X, Pang C, Hou X, Bao Y, Liu W, et al. Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS). Nephrol Dial Transplant. 2009;24:3724–31.
Zoppini G, Targher G, Chonchol M, Ortalda V, Negri C, Stoico V, et al. Predictors of estimated GFR decline in patients with type 2 diabetes and preserved kidney function. Clin J Am Soc Nephrol. 2012;7:401–8.
Ramirez SP, McClellan W, Port FK, Hsu SI. Risk factors for proteinuria in a large, multiracial, southeast Asian population. J Am Soc Nephrol. 2002;13:1907–17.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26:5–20.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130:461–70.
Lu WN, Li H, Zheng FP, Huang H, Ruan Y. Renal insufficiency and its associated factors in type 2 diabetic patients with normoalbuminuria. Zhonghua Nei Ke Za Zhi. 2010;49:24–7.
An JH, Cho YM, Yu HG, Jang HC, Park KS, Kim SY, et al. The clinical characteristics of normoalbuminuric renal insufficiency in Korean type 2 diabetic patients: a possible early stage renal complication. J Korean Med Sci. 2009;24:75–81.
Jun M, Zhu B, Tonelli M, Jardine MJ, Patel A, Neal B, et al. Effects of fibrates in kidney disease: a systematic review and meta-analysis. J Am Coll Cardiol. 2012;60:2061–71.
Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Arch Intern Med. 1998;158:998–1004.
Yuyun MF, Adler AI, Wareham NJ. What is the evidence that microalbuminuria is a predictor of cardiovascular disease events? Curr Opin Nephrol Hypertens. 2005;14:271–6.
Shumway JT, Gambert SR. Diabetic nephropathy-pathophysiology and management. Int Urol Nephrol. 2002;34:257–64.
Dmitrieva O, de Lusignan S, Macdougall IC, Gallagher H, Tomson C, Harris K, et al. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol. 2013;14:24.
Bulum T, Duvnjak L. Relationship between nonalcoholic fatty liver disease markers and renal function in patients with type 1 diabetes. Acta Med Croatica. 2011;65:6–10.
Cai J, Fan X, Mou L, Gao B, Liu X, Li J, et al. Association of reduced renal function with hepatitis B virus infection and elevated alanine aminotransferase. Clin J Am Soc Nephrol. 2012;7:1561–6.
Conflict of interest
The authors report no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yap, YS., Chien, CM. & Tai, YK. Associated factors of different combined albuminuria and estimated glomerular filtration rate stages among patients with type 2 diabetes mellitus. Int J Diabetes Dev Ctries 35 (Suppl 3), 362–368 (2015). https://doi.org/10.1007/s13410-015-0324-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-015-0324-1