Prevalence of microalbuminuria in type 2 diabetes patients in Tirana, a preliminary multicenter study

Nevi Pasko, Florian Toti, Ervin Zekollari, Arjana Strakosha, Viola Kacori, Nestor Thereska

Department of Endocrinology, University Hospital Center, Tirana, Albania.
Department of Nephrology Dialysis and Transplant, University Hospital Center, Tirana, Albania.

DOI: 10.4236/jdm.2013.33022                

Abstract

Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important to take measures to prevent or postpone overt nephropathy. This study aimed to investigate the prevalence of microalbuminuria in type 2 diabetes patients attending three diabetes centers in Tirana city. Patients and Methods: Two hundred and twenty patients with type 2 diabetes attending diabetes centers in Tirana were recruited in this crosssectional study. Medical records were used to collect data on duration of diabetes, waist circumference, history of hypertension, smoking. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. Results: The prevalence of normoalbuminuria was 58.3%, microalbuminuria 38.6% and macroalbuminuria 3.1%. Systolic and diastolic blood pressure (p < 0.01), HbA1c(p < 0.01) and fasting plasma glucose (p < 0.001) were significantly higher in microalbuminuric than in normoalbuminuric subjects. Multiple logistic regression analysis using microalbuminuria as the dependent variable in males shows that independent risk factors for diabetes patients with microalbuminuria were duration of diabetes, systolic blood pressure and waist circumference. We found that the OR for microalbuminuria became statistically significantly increased only at 16 years after the diagnosis of type 2 diabetes. At this time, 43.7% of patients had microalbuminuria. Conclusions: We found a high proportion of type 2 diabetes patients with microalbuminuria which raises implications for health policy inAlbania. This calls for early detection and good control of diabetes to reduce the burden of diabetic kidney disease in the future. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.

Keywords

Microalbuminuria; Type 2 Diabetes; Epidemiology; Albania

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	de Boer, I.H., Rue, T.C., Hall, Y.N., Heagerty, P.J., Weiss, N.S. and Himmelfarb, J. (2011) Temporal trends in the prevalence of diabetic kidney disease in the United States. Journal of the American Medical Association, 305, 2532-2539. doi:10.1001/jama.2011.861
[2]	Shapo, L., McKee, M., Coker, R. and Ylli, A. (2004) Type 2 diabetes in Tirana city, Albania: A rapid increase in a country in transition. Diabetic Medicine, 21, 77-83. doi:10.1046/j.1464-5491.2003.01093.x
[3]	International Diabetes Federation (2012) IDF diabetes atlas [Homepage on the Internet]. http://www.idf.org/diabetesatlas
[4]	Mongensen, C.E., Keane, W.F., Beneth, P.H., Parving, H.H. and Passa, P. (1995) Prevention of diabetic renal disease with special reference to microalbuminuria and macroalbuminuria. Lancet, 346, 1080-1084. doi:10.1016/S0140-6736(95)91747-0
[5]	Jong, P.E., Hillege, H.L., Joan, P.-S. and Zeeuw, D. (2003) Screening for microalbuminuria in the general population: A tool to detect subjects at increased risk for progressive renal failure in an early phase? Nephrology Dialysis Transplantation, 18, 10-13. doi:10.1093/ndt/18.1.10
[6]	Hiddo, J., Heerspink, L., Holtkamp, F. and Ravid, M. (2011) Monitoring kidney function and albuminuria in patients with diabetes. Diabetes Care, 34, 325-329. doi:10.2337/dc11-s247
[7]	de Zeeuw, D., Remuzzi, G. and Parving, H.H. (2004) Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL. Kidney International, 65, 2309-2320. doi:10.1111/j.1523-1755.2004.00653.x
[8]	Rowe, D.J., Dawnay, A. and Watts, G.F. (1990) Microalbuminuria in diabetic subjects. Annals of Clinical Biochemistry, 27, 297-312.
[9]	Croal, B.L., Mutch, W.J., Clark, B.M., Dickie, A., Church, J. and Noble, D. (2001) The clinical application of a urine albumin: Creatinine ratio point-of-care device. Clinica Chimica Acta, 307, 15-21. doi:10.1016/S0009-8981(01)00450-8
[10]	Marshall, S.M. (1991) Screening for MAU: Which measurement? Diabetic Medicine, 8, 706-711. doi:10.1111/j.1464-5491.1991.tb01688.x
[11]	Rowe, D.J., Dawnay, A. and Watts, G.F. (1990) Microalbuminuria in diabetic subjects. Annals of Clinical Biochemistry, 27, 297-312.
[12]	Amos, A., McCarty, D. and Zimmet, P. (1997) The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabetic Medicine, 14, S1-S85. doi:10.1002/(SICI)1096-9136(199712)14:5+3.3.CO;2-I
[13]	Zimmet, P., Alberti, K.G. and Shaw, J. (2001) Global and societal implications of the diabetes epidemic. Nature, 414, 782-787. doi:10.1038/414782a
[14]	Ritz, E., Rychlik, I., Locatelli, F. and Halimi, S. (1999) End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions. American Journal of Kidney Diseases, 34, 795-808. doi:10.1016/S0272-6386(99)70035-1
[15]	Ritz, E. and Orth, S.R. (1999) Nephropathy in patients with type 2 diabetes mellitus. The New England Journal of Medicine, 341, 1127-1133. doi:10.1056/NEJM199910073411506
[16]	Parving, H.H. (2001) Diabetic nephropathy: Prevention and treatment. Kidney International, 60, 2041-2055. doi:10.1046/j.1523-1755.2001.00020.x
[17]	Verhave, J.C., Gansevoort, R.T., Hillege, H.L., Bakker, S.J., De Zeeuw, D., de Jong, P.E., PREVEND Study Group (2004) An elevated urinary albumin excretion predicts de novo development of renal function impairment in the general population. Kidney International, 66, S18-S21. doi:10.1111/j.1523-1755.2004.09205.x
[18]	Atkins, R.C., Briganti, E.M. and Lewis, J.B. (2005) Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy. American Journal of Kidney Diseases, 45, 281-287. doi:10.1053/j.ajkd.2004.10.019
[19]	Bruno, G., Cavallo-Perin, P., Bargero, G., Borra, M., Calvi, V. and D’Errico, N. (1996) Prevalence and risk factors for microand macroalbuminuria in an Italian populationbased cohort of NIDDM subjects. Diabetes Care, 19, 43-47. doi:10.2337/diacare.19.1.43
[20]	Parving, H.H., Lewis, J.B., Ravid, M., Remuzzi, G. and Hunsicker, L.G. (2006) DEMAND investigators. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: A global perspective. Kidney International, 69, 2057. doi:10.1038/sj.ki.5000377
[21]	Toti, F., Bejtja, G., Hoti, K., Shota, E. and Agaci, F. (2007) Poor control and management of cardiovascular risk factors among Albanian diabetic adult patients. Primary Care Diabetes, 1, 81-86. doi:10.1016/j.pcd.2007.04.009
[22]	Mather, H.M., Chaturvedi, N. and Kehely, A.M. (1998) Comparison of prevalence and risk factors for microalbuminuria in south Asians and European with type 2 diabetes mellitus. Diabetic Medicine, 15, 672-677. doi:10.1002/(SICI)1096-9136(199808)15:8<672::AID-DIA648>3.0.CO;2-3
[23]	Retnakaran, R., Cull, C.A., Thorne, K.L., Adler, A.L. and Holman, R.R. (2006) Risk factors for renal dysfunction in type 2 diabetes: UK prospective diabetes study 74. Diabetes, 55, 1832-1839. doi:10.2337/db05-1620
[24]	Nilsson, P.M., Gudbjornsdottir, S., Eliasson, B., Cederholm, J., Steerng Committee of the Swedish National Diabetes Register (2004) Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes data from the National Diabetes Register in Sweden. Diabetes & Metabolism, 30, 261-268. doi:10.1016/S1262-3636(07)70117-9
[25]	Gall, M.A., Rossing, P., Scott, P., Damsbo, P., Vaag, A. and Bech, K. (1991) Prevalence of microand macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetologia, 34, 655-661. doi:10.1007/BF00400995
[26]	Caramori, M.L., Fioretto, P. and Mauer, M. (2000) The need for early predictors of diabetic nephropathy risk: Is albumin excretion rate sufficient? Diabetes, 49, 1399-1408. doi:10.2337/diabetes.49.9.1399