Albuminuria is More Prevalent in Type 1 Diabetes

Diabetes mellitus (DM) is a chronic metabolic disorder affecting up to 12% of individuals in the United States. Consisting of type 2 diabetes (T2DM) and type 1 diabetes (T1DM), DM is characterized by persistent hyperglycemia from partial insulin deficiency (insulin resistance) or absolute insulin deficiency.

DM can cause numerous complications, especially related to the kidneys. Diabetes is the primary cause of chronic kidney disease (CKD), and DM may cause a microvascular complication called diabetic kidney disease (DKD).

Early detection of DKD could reduce morbidity and mortality in diabetic patients, especially from events related to cardiovascular disease, according to the authors of a study published in the journal Cureus.

“Since CKD is independently associated with cardiovascular disease and death, its early detection and management significantly reduce morbidity and mortality,” the study authors wrote.

CKD is not entirely the same as DKD. According to the current study, CKD is defined as having abnormal kidney structure or function for longer than 3 months. DKD looks at urine to detect proteinuria that is above .5 g/24hr (also called overt nephropathy or macro albuminuria).

“We found CKD was common in both groups,” the study authors wrote.

However, more T1DM patients had albuminuria, indicative of the kidney disease subtype DKD. The current study looked at an entire diabetic population from an Irish primary care center. The researchers then determined the prevalence of nephropathy and albuminuria, studying the relationship between this disease and type of diabetes and the relationship with CKD.

Researchers identified and collected data on 7394 T2DM patients and 1166 T1DM patients from the Development and Integration of Accurate Mathematical Operations in Numerical Data-Processing (DIAMOND) database. Factors were gender, age, type of diabetes, serum creatinine, urinary albumin excretion, albumin creatinine ratio (ACR), body mass index, and last available glycated hemoglobin (HbA1c).

More than 40% of all T2DM patients had CKD present. Among T2DM patients with CKD, 25% were diagnosed with DKD, while the other 17% had primary CKD. In the T1DM cohort, 18% had CKD and 14% were diagnosed with DKD.

More T2DM patients suffered from non-albuminuric CKD than T1DM patients, which may be associated with separate factors such as hypertension, peripheral vascular disease, and dyslipidemia, signifying that DM is not the root cause of CKD—though it is not necessarily true, according to the study authors.

The increased prevalence of albuminuria in T1DM could also indicate that this population is at increased risk of cardiovascular disease, an independent risk factor associated with albuminuria, but not CKD.

Study limitations include CKD staging and albuminuria based on the most recent data. Additionally, there was no information about duration of diabetes, nor was the ethnicity recorded in the DIAMOND database. Finally, some cohorts did not have albuminuria status registered.

“Early detection and management of microalbuminuria are important to prevent its progression to worsening kidney disease,” the study authors wrote.

Reference

Majeed M, Ahmed F, Teeling M (December 06, 2022) The Prevalence of Chronic Kidney Disease and Albuminuria in Patients With Type 1 and Type 2 Diabetes Attending a Single Centre. Cureus 14(12): e32248. doi:10.7759/cureus.32248.