Association of Urine Albumin/Creatinine Ratio below 30 mg/g and Left Ventricular Hypertrophy in Patients with Type 2 Diabetes

Abstract

Several studies show that even a level of urine albumin/creatinine ratio (UACR) within the normal range (below 30 mg/g) increases the risk of cardiovascular diseases. We speculate that mildly increased UACR is related to left ventricular hypertrophy (LVH) in patients with type 2 diabetes mellitus (T2DM). In this retrospective study, 317 patients with diabetes with normal UACR, of whom 62 had LVH, were included. The associations between UACR and laboratory indicators, as well as LVH, were examined using multivariate linear regression and logistic regression, respectively. The diagnostic efficiency and the optimal cutoff point of UACR for LVH were evaluated using the area under the receiver operating characteristic curve (AUC) and Youden index. Our results showed that patients with LVH had significantly higher UACR than those without LVH (P<0.001). The prevalence of LVH presented an upward trend with the elevation of UACR. UACR was independently and positively associated with hemoglobin A1c (P<0.001). UACR can differentiate LVH (AUC = 0.682, 95% CI (0.602–0.760), P<0.001). The optimal cutoff point determined with the Youden index was UACR = 10.2 mg/g. When categorized by this cutoff point, the odds ratio (OR) for LVH in patients in the higher UACR group (10.2–30 mg/g) was 3.104 (95% CI: 1.557–6.188, P=0.001) compared with patients in the lower UACR group (<10.2 mg/g). When UACR was analyzed as a continuous variable, every double of increased UACR, the OR for LVH was 1.511 (95% CI: 1.047–2.180, P=0.028). Overall, UACR below 30 mg/g is associated with LVH in patients with T2DM. The optimal cutoff value of UACR for identifying LVH in diabetes is 10 mg/g.

The relationship between urinary albumin to creatinine ratio and all-cause mortality in the elderly population in the Chinese community: a 10-year follow-up study

“…Our observations add to more and more evidence, and they challenge the idea that UACR< 30 mg/g means albumin excretion is “normal” [ 27 ]. Our research is more focused on “normal” urine albumin excretion, so we divide the urine protein-creatinine ratio into three groups, divide the range of proteinuria with a limit of 30 mg/g, and then divide the “normal” urinary albumin to creatinine ratio by 10 mg/g is divided into two groups.…”

“…In 2020, another Chinese study showed that urinary albumin-creatinine ratio (UACR) within the normal range (less than 30 mg/g) would also increase the risk of cardiovascular disease. The optimal cut-off value of UACR for diagnosing diabetic left ventricular hypertrophy is 10 mg/g [ 27 ]. In our study to predict all-cause death, we used the same cut-off value, and the results were similar.…”

Identifying Distinct Risk Thresholds of Glycated Hemoglobin and Systolic Blood Pressure for Rapid Albuminuria Progression in Type 2 Diabetes From NHANES (1999–2018)

“…Notably, A cohort study with an up to11-year follow-up period found that protein excretion levels, even with normal at baseline, are pronouncedly associated with increased mortality risk from CVD ( 17 ). A recent study also confirmed that a normal ACR range (≤30 mg/g) was related to left ventricular hypertrophy in patients with T2DM ( 18 ). This suggested that the specific numerical changes of ACR and the risk thresholds might not be fully reflected when we simply treated ACR as a categorical variable with a 30 mg/g cut-off.…”

Diabetic nephropathy: early markers for monitoring and prevention

“…22,24 Xie et al studied and found association between UACR and left ventricular hypertrophy in Type 2 diabetes patients. 26 Lo et al studied and found beneficial effects of SGLT-2 inhibitor Empagliflozin on cardiovascular and Renal outcomes in Diabetic patients. 25 Our study compared Diabetic patients with and without Hypertension for UACR and eGFR.…”