Risk Factors for Albuminuria in Normotensive Older Adults with Type 2 Diabetes Mellitus and Normal Renal Function: A Cross-Sectional Study

Abstract

Introduction Diabetes mellitus (DM) is prevalent in developed and developing countries, including China. However, few studies have examined the potential risk factors for albuminuria in normotensive older adults with type 2 DM and normal renal function. Methods We recruited normotensive older adults (≥ 65 years) with type 2 DM and normal renal function from the First Affiliated Hospital of Soochow University from January to December 2019. We stratified participants according to their urine albumin to creatinine ratio (ACR) into the following groups: normal ACR (ACR1), microalbuminuria (ACR2), and macroalbuminuria (ACR3). Demographic characteristics, anthropometric parameters, and metabolic profiles were recorded. Creatinine clearance (Ccr) and homeostasis model assessment—insulin resistance (HOMA-IR) were calculated. Logistic regression was used to examine risk factors for albuminuria. Results A total of 250 older adults were enrolled during the study period, including 124, 82, and 44 with normal albuminuria, microalbuminuria, and macroalbuminuria, respectively. We found that an extended duration of DM (odds ratio [OR] 1.085, 95% confidence interval [CI] 1.012–1.164, P = 0.022), elevated systolic blood pressure (OR 1.049, 95%CI 1.018–1.081, P < 0.01), elevated glycated hemoglobin (OR 1.734, 95% CI 1.332–2.258, P < 0.01), low insulin (OR 0.871, 95% CI 0.804–0.944, P < 0.01), and low C-peptide (OR 0.365, 95% CI 0.239–0.588, P < 0.01) were independent risk factors for albuminuria. Conclusion Elevated blood pressure, low insulin, low C-peptide, and poor glycemic control were significant risk factors for albuminuria. These parameters may serve as early indicators for intervention.

The Role of Transferrin and Laminin Biomarkers in the Diagnosis of Diabetic Nephropathy in Type II Diabetic Patients

“…In the current study there was statistically significant difference in the incidence of Hypertension among study groups. This finding agreed with Zhou et al [32] study which consisted of 250 older adults were enrolled during the study period, including 124, 82, and 44 with normal albuminuria, microalbuminuria, and macroalbuminuria, respectively. They found that an elevated blood pressure was independent risk factor for albuminuria.…”

Integrative analyses of biomarkers and pathways for diabetic nephropathy

“…We selected 14 of these pathways that met NES ≥ 2.0 and the adjusted p -value < 0.05 for GSEA enrichment analysis to be shown ( Table 3 ). These data sets include ( Cho et al, 2018 ): TYROBP causal network ( GBD Chronic Kidney Disease Collaboration, 2020 ); Interleukin 10 signaling ( Wang et al, 2021 ); Inflammatory response pathway ( Liu et al, 2021 ); Involved in chemokine receptor-binding ( Ma et al, 2019 ); Involved in cell adhesion molecules, CAMS ( Bakris and Molitch, 2014 ); Interferon γand α signaling pathways ( Macisaac et al, 2014 ); Type II interferon signaling, IFNG ( Sourris and Forbes, 2009 ); Antigen processing and presentation ( Persson and Rossing, 2018 ); Reactome complement cascade ( Bjornstad et al, 2015 ); Reactome tcr signaling ( MacIsaac and Jerums, 2011 ); Biocarta CTL pathway ( MacIsaac and Ekinci, 2019 ); ECM receptor interaction ( Zhou et al, 2021 ); PID integrin1 pathway ( MacIsaac et al, 2015 ); Chemokine pathway; and so on. Then, the results of the GSEA enrichment analysis were visualized and presented ( Figure 7 ).…”

“…It is common practice to detect microalbuminuria at the early stages of DN; However, some patients with microalbuminuria have advanced renal disease. Microalbuminuria is influenced by many factors, and its reliability and accuracy are disputed ( Zhou et al, 2021 ). At the same time, eGFR does not exactly reflect measured GFR (mGFR), which could lead to an underlying misclassification of renal function ( MacIsaac et al, 2015 ).…”

High levels of serum C-peptide are associated with a decreased risk for incident renal progression in patients with type 2 diabetes: a retrospective cohort study

“…A small cross-sectional study in China showed that low-level C-peptide was an independent risk factor for proteinuria in T2DM patients. 26 Bo et al 27 conducted a retrospective cohort study of 931 T2DM patients with a median follow-up period of 14 years and showed that a higher level of C-peptide could reduce the risk of chronic complications, including DKD. A total of 357 T2DM patients were grouped by the severity of proteinuria and eGFR in Wang et al ’s 28 study, and they revealed that a low level of C-peptide was associated with the progression of diabetic nephropathy.…”

“…It was confirmed that higher levels of 2hPCP, ΔCP, and PCGR could delay the occurrence of renal composite endpoint events. A small cross-sectional study in China showed that low-level C-peptide was an independent risk factor for proteinuria in T2DM patients 26. Bo et al 27 conducted a retrospective cohort study of 931 T2DM patients with a median follow-up period of 14 years and showed that a higher level of C-peptide could reduce the risk of chronic complications, including DKD.…”