Risk factors of micro-albuminuria in patients with non-insulin dependent diabetes mellitus

Abstract EN

Background and aim : Micro-albuminuria is an indicator of early diabetic nephropathy (DN).

The trends towards increased end stage renal disease (ESRD) secondary to DN are expected to contiune in develping countries.

An understanding of the risk factors, which lead to the development of micro-albuminuria in non-insulin dependent diabetes mellitus (NIDDM), is required to develop strategies for primary prevention of DN.

Subjects and methods : A case-control design was used to determine the risk factors of early DN in 184 patients with NIDDM (48 with micro-albuminuria and 136 with normo-albuminnria).

We defined micro-albuminuria where the ratio of urine albumin in lhicrograms- OritfgW uririe ereatirtine in milligrams (mg) was in the range of 17-299 for males and 25-299'for females.

The glycosylated hemoglobin (HbAlc) of 28:1 % was used to define the poor glycemic control.

Patients were examined for retinopathy, peripheral neuropathy, coronary artery disease (CAD) and peripheral vascular disease (PVD).

We measured fasting serum triglyceride, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), lipoprotein (a) (Lp(a)), C-peptide of insulin, transforming growth factor beta (TGF|$) and e-selectin.

Results: HbAlc, duration of diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP) and $erum C-peptide of insulin, triglyceride, LDL and Lp(a) were positively correlated with micro-albuminuria, while HDL was inversely correlated with it.

The TGF? and e-selectin did not significantly correlated with micro-albuminuria (P>0.05).

After adjustments for the effects of covariates with logistic regression (LR) analysis, the odds ratio (OR) and 95% confidence interval (Cl) of micro-albuminuria for the potential risk factors were estimated.

LR reveated a significant association between micro-albuminuria and male gender (OR = 5.1); poor glycemic control (OR = 4.7), young age at onset of diabetes (OR = 4.1), dyslipidemta (OR = 3.8), hypertension (OR= 3.1), and the longer duration of diabetes mellitus (OR * 2.6).

Conclusions: Male gender, poor glycemic control, young age at onset of diabetes, long duration of diabetes, hypertension and disturbed lipid profile especially triglyceride, LDL and Lp(a) are significant risk factors for development of DN.

The possible mediators of progression of nephropathy (serum TGFjJ, e-selectin and insulin) are not found to be significant markers of micro-albuminuric stage of DN.