Independent Determinants of Urinary Albumin Excretion and Confounding Variables in Type 2 Diabetic Patient

Abstract

Sunita Neupane, Sujata Shrestha

Background: Microalbuminuria is a known risk factor for the development of clinical nephropathy in diabetes and also an independent risk factor for cardiovascular disease. Microalbuminuria is a marker of a pathophysiological process that causes both increased renal albumin loss and atherothrombosis. Microalbuminuria is hallmark for early detection of diabetic nephropathy. An elevated urinary albumin excretion is a marker of endothelial dysfunction that symbolizes the kidney’s way to translate the existence of vascular damage. The aim of this study was to evaluate the independent determinants of urinary albumin excretion, and association between biochemical parameters and socio-demographic factors in Diabetic patients.

Materials and Methods: This is a hospital based cross sectional study included diagnosed case of Diabetic patients. Serum uric acid concentrations were measured by enzymatic method (uricase-peroxidase), HbA1c was measured using the principle of dry chemistry, Blood Sugar measured by Glucose oxidase peroxidase (GOD/POD) method and urinary albumin excretion was measured with an immunoturbidometric assay.

Results: Based on categorization of Urinary albumin excretion, 65% normoalbuminuric, 27% microalbuminuric and 8% macroalbuminuric are found in our study population. The frequency of hyperuricemia was found to be 43%. The prevalence of albuminuria increased significantly with increasing glycaemia. Pearsons Correlation coefficient by bivariate analysis of Urinary albumin excretion with confounding variables shows significant positive correlation with onset of DM (r=0.203, P=0.013), Systolic Blood Pressure (r=0.355, P=0.001), Diastolic Blood Pressure (r=0.405, P=0.001), Uricacid (r=0.352, P=0.001), HbA1c (r=0.212, P=0.005) and Smoking (r=0.265, P=0.01). Multiple regression test shows that independent determinant of UAE are Blood Pressure {Diastolic (β=0.313, P=0.006) /Systolic (β=0.309, P=0.002)}, HbA1c (β=0.187, P=0.010), Uric acid (β=0.331, P=0.0001) and Onset of DM (β=0.199,P=0.041).

Conclusion: Albuminuria is therefore an important risk factor to measure in patients at risk. The findings extend the relationship between confounding variables and the urinary albumin excretion which emphasize on the importance of screening for microalbuminuria, Serum Uric Acid to prevent renal dysfunction, HbA1c measurement on a regular interval for good glycemic control and the other variables for regular physiological process of body. Further examination is needed in a large population size to clarify the validity between the biochemical parameters

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