Association Between Albuminuria And Estimated Glomerular Filtration Rate And Vascular Complications Of Type 2 Diabetes

Objective: To investigate the association between albuminuria and estimated glomerular filtration rate(e GFR)and vascular complications on patients with type 2 diabetes.Methods:From April 2008 to November 2018,4715 patients with type 2 diabetes were recruited and grouped based on the values of UACR and e GFR(urine albumin-tocreatinine ratio(UACR)≥ 30 mg/g or UACR<30 mg/g;stage 1:e GFR ≥ 90 m L/min/1.73m2,Stage 2:e GFR = 60-89 m L/min/1.73m2,stages 3-5:e GFR<60m L/min/1.73m2).The detection rates of diabetic retinopathy,diabetic peripheral neuropathy,low brachial ankle index,left ventricular remodeling and diastolic disorder were compared in different groups,the association between two phenotypes of diabetic kidney and vascular complications was evaluated after multiple factors were corrected by binary regression.To compare the relationship between the increase of vascular complications and the change of UACR/e GFR at the end of the follow-up period.Results: 1.With the increase of urinary protein and the decline of e GFR,the detection rate of diabetic vascular complications has a rising trend.2.After adjusting cofounders,binary logistic regressions were applied in 6 subgroups showed that the association between diabetic complications and UACR/e GFR remains significant.3.In the same stage of e GFR subjects,those cases with the albuminuria have 3.705-fold risk of diabetic peripheral neuropathy compared with the normoalbuminuric subjects(OR=3.705,95%CI:1.273-10.781,P=0.161),2.937-fold risk for left ventricular remodeling(OR=2.937,95%CI:1.423-6.061,P=0.004),and 5.345 fold risk for diastolic disorders(OR=5.345,95%CI:1.971-14.546,P= 0.001).However,no significant differences were observed in normoalbuminuric subjects in different e GFR-based groups.4.ROC curve about complications and UACR: UACR ≥ 26.3 and 48.76 mg/g necessitates screening micro-vascular complications and macro-vascular complications,respectively.5.Compared with the group of urinary protein decreased ≥30%,the group of UACR increases ≥30% had a higher risk of microvascular complication,and diabetic retinopathy is significant[P=0.027,OR=2.380,95%CI 1.104-5.131;P=0.041,OR=2.122 95%CI 1.033-4.359],it was insignificant when analyzing e GFR.as well in macrovascular complications.6.No significant differences were observed in eGFR decreased ≥3%group while compared with e GFR stable group(P<0.05).Conclusions: Albuminuria is a more predictive risk factor of diabetic complications than reduced e GFR,and when UACR level is higher than 26.3 mg/g,screening vascular complications is highly recommended,especially for micro-vascular complications.