| Research purposeThrough investigation and analysis of the morning urine sample from elderly citizens(≧60 years old) from Junliangcheng community, Dongli district, Tianjin, China, we aim to:(1) survey the prevalence of albuminuria in elderly population, analyze its clinical and environmental risk factors and expect that these findings could have some clinical significance in reducing the risk of having albuminuria;(2) evaluate the prevalence of proteinuria in elderly population and the percentage of glomerular proteinuria and renal tubular proteinuria, analyze the risk factors of the different types of proteinuria;(3) explore the concordance of evaluating albuminuria between second morning voids and first morning void urine samples in elderly people. Research contents and methods1. The urine samples in the morning and the clinical data from 2050 old citizens who took part in healthy examination were collected. The concentration of urine albumin and creatinine were tested, and the ACR was calculated. We analyzed the prevalence of albuminuria, and used logistic regression to analyze the odd ratio(OR) of risk factors.2. 714 elderly citizens were included, ACR and α1-microglobulin/creatinine ratio(MCR) from morning urine sample were estimated by using Nephelometry. We assessed the proportion of different types of proteinuria in the elderly population by analyzing ACR and MCR.3. 191 participants from Elderly Physical Examination population in Tianjin Jun Liangcheng hospital provide two urine samples: first morning sample and second morning sample. Urine albumin concentration and urine creatinine were measured and urine albumin-creatinine ratio(ACR)was calculated. Then we compared ACR or UAC in first morning voids(ACR1 or UAC2) with ACR or UAC in second morning voids(ACR2 or UAC2), estimated the consistency of assessing albuminuria between the two samples in elderly population. Results1. In the whole 2050 participates, 56.69% were hypertension patients, 12.86% were diabetes patients, 27.71% were participants with albuminuria. The prevalence of ACR>30mg/g was 21.61% in men and 32.55% in women. The risk of prevalence of albuminuria in men was significantly lower than in women(OR=0.58,P<0.05). The OR of having an increased ACR was 1.45 in 70-79 y citizens compared with 60-69 y citizens, and the OR was 1.89 in >80y old people. However, after adjusting confounding factors, the OR of having albuminuria in women was still significantly higher than in men. Body mass index and waist circumference were not the risk factors of increased ACR after adjusting gender and age factors. There was an association between the prevalence of albuminuria and triglycerides(OR=1.19), hypertension(OR=1.68), diabetes(OR=1.95). ACR value was increased as the rising number of cigarettes, however, there was also no association between smoking and albuminuria(P>0.05). The ACR values was decreased with the increased frequency of physical activity. Especially in the participants who undertook activity once/day, the OR of having albuminuria was obviously lower than the participants who had no activity(OR=0.52,P=0.027).2. Of the 714 enrolled subjects, 29.13% of participants had increased ACR, 46.36% had the increased MCR. The percent of participants with increased ACR or MCR was 53.78%. Overall, tubular proteinuria was dominant in three types of proteinuria(45.83%), followed by mixed glomerular and tubular proteinuria(35.68%). The proportion of tubular micro-proteinuria was significantly higher than proportion of glomerular proteinuria. Obesity(odd ratio, OR=1.40, P=0.037) and high salt diet(OR=1.32, P=0.043) were the independent risk factors of tubular proteinuria; however, gender(OR=0.64, P=0.044) and physical activity(OR=0.53, P=0.001) were the independent risk factors of glomerular proteinuria, the risk in male was lower than in female.3. 191 participants are included in this study. In overall, the prevalence of albuminuria is 23.6%, with a higher proportion in diabetes and hypertension groups(28.1% and 29.0%). The proportion of increased ACR2 is slightly higher than increased ACR1 in every group, but there are no statistical differences(p>0.05 in every groups). Similarly, no statistical differences exist between the values of albumin in first and second morning urine ACR(p=0.271),and they are highly correlated. The correlation of values between ACR1 and ACR2 is significantly higher than correlation between UAC1 and UAC2(0.901 vs o.797), especially in male group(0.938). The two samples have high concordance of assessing albuminuria, and the concordance in ACR is higher than in UAC(0.815 vs 0.627 for κ coefficient), with a higher agreement in male group(κ=0.900) and the hypertension group(κ=0.850). Conclusion1. The prevalence of albuminuria is high in the elderly population(27.71%), and it is significantly correlated with gender, hypertension, diabetes and triglycerides. Hypertension, diabetes and lipid metabolic disorders are all the risk factors of albuminuria, good control of blood pressure, glucose and triglycerides could reduce the ACR values. In addition, good life habits also could reduce the risk of having albuminuria.2. The prevalence of micro-proteinuria is much higher than the prevalence of albuminuria, the single test of albuminuria may not selected out all the participant who have tubular proteinuria in elderly population. Meanwhile, the presence of tubular proteinuria may be more common than glomerular proteinuria. Furthermore, physical activity, low salt diet and losing weight may reduce the risk of having micro-proteinuria, it is important to maintain a good life style for elderly population.3. The correlation and agreement of albuminuria status between ACR1 and ACR2 are significantly higher than those between UAC1 and UAC2, ACR has the lower intra-individual CV than UAC. Second morning ACR are highly consistent with first morning ACR to assess albuminuria in elder population, it is feasible to use second morning voids as alternative to first morning voids for assessing albuminuria. |
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