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Summary: Clinical and laboratory correlates of chronic kidney disease (CKD) in sickle cell anaemia remain incompletely defined. In a multicenter cohort study, we evaluated the prevalence of persistent albuminuria (PA) and characteristics associated with PA, albumin–creatinine ratio (ACR) and decreased estimated glomerular filtration rate (eGFR) using logistic, linear and multinomial regression models, respectively. Of 269 participants (median age: 30 years; 57.2% females), the prevalence of PA was 35.7%. Using baseline ACR values of <100 and ≥100 mg/g, the probabilities of PA were 30.0% and 94.6%, respectively. In multivariable logistic regression analyses, male sex (β = 0.80 [SE = 0.36], p = 0.024) and ACE inhibitors/ARBs use (β = 1.54 [SE = 0.43], p < 0.001) were associated with higher likelihoods of PA, while higher haemoglobin (β = −0.33 [SE = 0.13], p = 0.009) and HbF (β = −0.04 [SE = 0.02], p = 0.041) were associated with lower likelihoods of PA. In multivariable multinomial regression analyses, older age (β = 0.06 [SE = 0.02], p = 0.004) and higher alkaline phosphatase (β = 0.01 [SE = 0.00], p = 0.004) were associated with higher odds of having eGFR 60–90 versus eGFR>90 mL/min/1.73 m2 using the cystatin C‐based CKD‐EPI‐2012 equation. Additionally, higher systolic blood pressure (β = 0.11 [SE = 0.03], p = 0.001) and blood urea nitrogen (β = 0.45 [SE = 0.12], p < 0.001) were associated with higher odds, while higher haemoglobin (β = −1.22 [SE = 0.43], p = 0.004) was associated with lower odds of having eGFR<60 versus eGFR>90 mL/min/1.73 m2. PA and decreased eGFR are associated with measures of disease severity and comorbid conditions (Clinicaltrials.gov Identifier: NCT03277547). [ABSTRACT FROM AUTHOR]

Epidemiologic studies show high circulating Branched-chain amino acids (BCAA) are associated with excess body weight, impaired fasting glucose, insulin resistance, high blood pressure, and dyslipidemia. There is scarce data on the association between renal function and circulating levels of BCAA. Therefore, we aim to study this association in a sample of the Brazilian Longitudinal Study of Adults (ELSA-Brasil) We analyzed participants who had at the baseline BCAA: valine, isoleucine, and leucine measured through nuclear magnetic resonance. The outcomes evaluated were estimated glomerular function (eGFR - CKD-EPI without race) and 12h-albumin-creatinine ratio (ACR). In addition, we built unadjusted and adjusted multivariable linear regression models to investigate the association between the BCAA (total and individual) and eGFR and ACR. We studied 4912 participants (age 51.7(±9.0) years, 53.4% women, 59.5% White (59.5%), 32.7% hypertension, and 18.2% diabetes). The mean BCAA level was 429.15 ± 87.15. The mean eGFR was 84.95 ± 15 ml/min/1.73 m2, and the median ACR was 6.5 (1.8–4920) mg/g. Descriptive analyses comparing eGFR stratified <60 ml/min/1.73 m2 and ACR≥30 mg/g demonstrate that BCAA levels are higher in patients with eGFR<60 and ACR ≥30. Regarding eGFR, an inverse association was detected with BCAA levels when adjusted for demographic variables, and it is not maintained after adjustments for other confounders. Also, a positive association was found for ACR≥30 mg/g, and BCAA levels, and this association is not confirmed after adjustments. BCAA levels were inversely associated with eGFR and positively associated with ACR. Further studies are necessary to allow the comprehension of those associations. [ABSTRACT FROM AUTHOR]

Introduction. This study was an attempt to detect the relationship between chronic kidney disease (CKD) and anthropometric indices in presence of confounding variables. Methods. A cross-sectional study of 3375 participants was designed in Isfahan city. Waist-height ratio (WHtR), waist-hip ratio (WHR), body mass index (BMI) and waist circumference (WC) were measured. Participants were divided into CKD and non-CKD groups according to the calculated albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Then, the groups were subdivided into sub-groups of high and normal anthropometric indices. Results. To evaluate CKD in relation to anthropometric indices, odds ratio was calculated; in the female group, no association was observed (P = .05). However, in the male group high levels of WHtR and BMI were associated with CKD (P value of .002 and .015, respectively). To evaluate the association between ACR and eGFR with anthropometric indices linear regression analysis was performed. There was no significant relation between ACR and eGFR with anthropometric indices in both sexes in a fully adjusted state (P = .05). Conclusion. High WHtR and BMI probably are associated with CKD in male. WHR and WC have no relation to the occurrence of CKD. There are no significant changes in regard to ACR and eGFR. [ABSTRACT FROM AUTHOR]

In adults, albuminuria represents a risk factor for cardiovascular disease and is associated with hypertension and obesity. Pediatric data from the general population are inconsistent and largely based on randomly collected urine. A possible association between antenatal programming and albuminuria at school age has still to be investigated. The purpose of this study is to assess albuminuria in first morning void urine samples in a population-based pediatric cohort and to investigate cross-sectionally the association with factors related to cardiovascular risk. Moreover, we investigate the possible association of antenatal factors with albuminuria. A first morning void urine sample was collected in the population-based GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort at the age of 12 years. We investigated cross-sectionally associations between albuminuria and body mass index (BMI), waist circumference (WC), blood pressure (BP) and antenatal factors. The prevalence of UACR (urinary albumin-creatinine ratio) ≥ 3 mg/mmol was 3.3% (95%CI 2.3–4.2). In a multivariate linear regression model, UAC was negatively associated with z-BMI (β-0.08, p = 0.013) and positively with z-systolic BP (β 0.09, p = 0.006), model significance p = 0.002. UACR was negatively associated with z-BMI (β − 0.13, p < 0.001) and positively with z-diastolic BP (β 0.09, p = 0.003), model significance p = 0.001. Albuminuria was not significantly associated with antenatal factors such as gestational age and standardized birth weight. Conclusions: Albuminuria in first morning void urine in 12-year-olds has a lower prevalence than previously reported by randomly collected samples. A negative association between albuminuria and BMI is confirmed. A positive association with blood pressure, but no association with antenatal factors was found. What is known: • While, in adults, albuminuria is a recognized risk factor for cardiovascular disease and is associated with hypertension and obesity, pediatric data are inconsistent and largely based on randomly collected urine. • A possible association between antenatal programming and albuminuria at school age has still to be investigated. What is new: • In this population study on first morning void urine samples from 12-year-olds of the general population, albuminuria is negatively associated with body mass index, and positively associated with blood pressure, while there is no association with antenatal factors. • The prevalence of albuminuria at 12 years is lower than previously reported in studies based on randomly collected urine samples, probably due to elimination of orthostatic proteinuria. [ABSTRACT FROM AUTHOR]

Abstract Background It is well established that the consumption of trans-fatty acids (TFAs) can increase the incidence of total mortality, cardiovascular disease, cancer, and diabetes. However, there are still no demographic studies on the effects of circulating TFA isoforms on the albumin-creatinine ratio (ACR), an early marker of chronic kidney disease. Our goal was to explore the possible relationships between TFAs and ACR. Methods In this study, complete TFAs and urinary ACR data were collected from the National Health and Nutrition Examination Survey (NHANES) (2009–2010 and 1999–2000 cycles). The independent linear relationships between different circulating TFA isoforms and the ACR were examined by performing multivariable linear regression models. Machine learning was used to analyze the contribution of the different TFA isoforms to the ACR. To assess the nonlinearity of the relationship, smooth curve fitting and an analysis of threshold effect were performed, and a stratified analysis was conducted to identify possible susceptible populations. Results Our analysis included a total of 3785 individuals. Elaidic acid, linolelaidic acid, and sum TFAs were shown to be positively associated with the ACR after full adjustment by weighted multivariable regression analysis. In the subgroup analysis, the positive associations were maintained in participants with hypertension and without diabetes. In the XGBoost model of the ACR, Sum TFAs were found to be the most crucial factor. In addition, smooth curve fitting showed that there was a nonlinear relationship between the different TFAs and the ACR, and there was a saturation point. Conclusions Our study demonstrated that TFA isoforms were positively and independently correlated with urinary albumin excretion, especially in participants with hypertension and without diabetes. This suggested that reducing trans fatty acid intake may reduce the risk of renal events.

Background Albuminuria is a known marker of mortality risk. Whether the association between albuminuria and mortality differs by demographic and comorbidity factors remains unclear. Therefore, we sought to determine whether albuminuria is differentially associated with mortality. Methods and Results This study included 49 640 participants from the National Health and Nutrition Examination Survey (1999–2018). All‐cause mortality through 2019 was linked from the National Death Index. Multivariable‐adjusted Poisson regression models were used to determine whether levels of urine albumin‐to‐creatinine ratio (ACR) were associated with mortality. Models were adjusted for demographic, socioeconomic, behavioral, and clinical factors. Mean age in the population was 46 years, with 51.3% female, and 30.3% with an ACR ≥10 mg/g. Over a median follow‐up of 9.5 years, 6813 deaths occurred. Compared with ACR

Background: It is well established that the consumption of trans-fatty acids (TFAs) can increase the incidence of total mortality, cardiovascular disease, cancer, and diabetes. However, there are still no demographic studies on the effects of circulating TFA isoforms on the albumin-creatinine ratio (ACR), an early marker of chronic kidney disease. Our goal was to explore the possible relationships between TFAs and ACR. Methods: In this study, complete TFAs and urinary ACR data were collected from the National Health and Nutrition Examination Survey (NHANES) (2009–2010 and 1999–2000 cycles). The independent linear relationships between different circulating TFA isoforms and the ACR were examined by performing multivariable linear regression models. Machine learning was used to analyze the contribution of the different TFA isoforms to the ACR. To assess the nonlinearity of the relationship, smooth curve fitting and an analysis of threshold effect were performed, and a stratified analysis was conducted to identify possible susceptible populations. Results: Our analysis included a total of 3785 individuals. Elaidic acid, linolelaidic acid, and sum TFAs were shown to be positively associated with the ACR after full adjustment by weighted multivariable regression analysis. In the subgroup analysis, the positive associations were maintained in participants with hypertension and without diabetes. In the XGBoost model of the ACR, Sum TFAs were found to be the most crucial factor. In addition, smooth curve fitting showed that there was a nonlinear relationship between the different TFAs and the ACR, and there was a saturation point. Conclusions: Our study demonstrated that TFA isoforms were positively and independently correlated with urinary albumin excretion, especially in participants with hypertension and without diabetes. This suggested that reducing trans fatty acid intake may reduce the risk of renal events. [ABSTRACT FROM AUTHOR]

Background: Mildly increased albuminuria is common in the general adult population and is a strong predictor for cardiovascular events, even in otherwise healthy individuals. The underlying pathophysiological process could be endothelial dysfunction. Previously, we reported that increased albuminuria can also be found in 2-year-olds from the general population. We hypothesized that some individuals have constitutionally higher levels of albuminuria, possibly as an expression of early or inborn endothelial dysfunction. The aim of this study is to evaluate longitudinal persistence of albuminuria from infancy into school age. Methods: In the population-based GECKO (Groningen Expert Center for Kids with Obesity) cohort, urine was collected from 816 children at the age of 2 years as well as 12 years (random urine and first morning void urine, respectively). We evaluated prevalence and persistence of increased albuminuria (UACR ≥ 3 mg/mmol) at the two time points. Results: The prevalence of UACR ≥ 3 mg/mmol at 2 and 12 years of age was 31.9% (95% CI 28.7–35.2) and 3.1% (95% CI 2.0–4.5), respectively. UACR < 3 mg/mmol at both 2 and 12 years of age was present in 540 children (66.2%). Only 9 children (3.5%) of the 260 children with an UACR ≥ 3 mg/mmol at 2 years had an UACR ≥ 3 mg/mmol at 12 years (p < 0.001). Conclusion: Albuminuria in 2-year-olds does largely not persist until the age of 12, indicating that albuminuria at 2 years of age is not a marker for constitutional endothelial dysfunction in this cohort. [ABSTRACT FROM AUTHOR]

Elevated urinary albumin-creatinine ratio (ACR) is an established risk factor for lower extremity peripheral arterial disease (PAD) in non-diabetes individual. This study aimed to determine the relationship between urinary ACR level and PAD in diabetes population. A cross-section study with 1396 hospitalized diabetes participants from department of endocrinology and neurology were performed and the propensity score matching method was applied to reduce the effects of confounding factors between the matched PAD and Non-PAD groups. The relationship between urinary ACR and ankle–brachial index (ABI) was analyzed by linear curve fitting analyses and multiple logistic regression models. Our study showed that the prevalence of PAD (low ABI, ABI<0.9) was 7.09% in our diabetes patients. The ABI level was significantly lower in high ACR group compared with those in normal urinary ACR group (1.11 ± 0.17 vs 1.13 ± 0.15, p = 0.010). The prevalence of PAD was increased with the increased tertile's of log2-transformed ACR in total patients before and after propensity score matching (p < 0.001 and p = 0.007, respectively). The OR (95% CI) between log2-transformed ACR and PAD was 1.0 and 1.70 (1.08–2.69, p = 0.022) respectively in normal and high ACR levels in diabetes patients after adjusting for potential confounders. After propensity score matching, the OR (95% CI) between log2-transformed ACR and PAD was 1.0 and 1.85 (1.05–3.23, p = 0.031) respectively in normal and high ACR levels in diabetes patients after adjusting for potential confounders. The elevated urinary ACR level was associated with PAD in Chinese diabetes patients. • The mean ABI levels decreased with the increase of ACR levels in total patients before and after propensity score matching. • Positive linear relationships between log2-transformed ACR and incidence of low ABI. • Curvilinear relationships between log2-transformed ACR and incidence of high ABI. • Positive association between urinary ACR and lower extremity peripheral arterial disease in diabetes patients. [ABSTRACT FROM AUTHOR]

Urine albumin concentration and albumin–creatinine ratio are important for the screening of early-stage kidney damage. Commutable urine certified reference materials (CRMs) for albumin and creatinine are necessary for standardization of urine albumin and accurate measurement of albumin–urine ratio. Two urine CRMs for albumin and creatinine with certified values determined using higher-order reference measurement procedures were evaluated for their commutability on five brands/models of clinical analyzers where different reagent kits were used, including Roche Cobas c702, Roche Cobas c311, Siemens Atellica CH, Beckman Coulter AU5800, and Abbott Architect c16000. The commutability study was conducted by measuring at least 26 authentic patient urine samples and the human urine CRMs using both reference measurement procedures and the routine methods. Both the linear regression model suggested by the Clinical and Laboratory Standard Institute (CLSI) guidelines and log-transformed model recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Commutability Working Group were used to evaluate the commutability of the human urine CRMs. The commutability of the human urine CRMs was found to be generally satisfactory on all five clinical analyzers for both albumin and creatinine, suggesting that they are suitable to be used routinely by clinical laboratories as quality control or for method validation of urine albumin and creatinine measurements. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus is the most common cause of diabetes, consist from about 85% of cases. Diabetic nephropathy is a complication of diabetes mellitus in the kidneys which can end up as kidney failure. Podocalyxin (PDX) is a protein expressed in kidney podocytes that is involved in various cancers, and is also essential for kidney development. The research design was carried out using observational and cross-sectional analytic methods with total participants of 25 DM with diabetic nephropathy and 25 DM without diabetic nephropathy with a purposive probability sampling technique. This research conducted at the Endocrine Polyclinic, Clinical Pathology Laboratory, Hasanuddin University Medical Research Center (HUM-RC) Laboratory, Hasanuddin University Hospital, Makassar. The results showed that the urinary PDX level in DM subjects with nephropathy were 1.160 ng/mL and DM without nephropathy were 0.167 ng/mL (p

Background: Outside of pregnancies, the protein-to and albumin-to creatinine ratios have been extensively investigated and applied. In most cases, these tests (rather than a 24-hour urine collection) are currently what the National Kidney Foundation advises for diagnosing proteinuria. The aim of the present study is to compare the diagnostic accuracy of the random urine albumin-creatinine ratio (ACR) to that of the gold standard, the 24-hour urinary protein, in patients with preeclampsia. Patients and methods: At Said Galal Hospital, we enrolled 100 women who had been diagnosed with hypertension problems during pregnancy and were admitted for further diagnostic testing. Albumin 24 hour collection and albumin creatinine ratio (ACR) were measured for all participants. Results: Albumin in a 24-hour urine collection was positively correlated with albumin-to-creatinine ratio in a random urine sample (r = 0.935, P <0.001). ACR of 303 mg/g creatinine was found to be the "ideal" cutoff value for the identification of substantial proteinuria with a sensitivity of 96% and a specificity of 92%. Albumin creatinine ratio cutoff value for predicting severe proteinuria in cases of preeclampsia was 2 gm/24hr. We found that cutoff value of >1238 mg/g creatinine had a sensitivity of 100% and a specificity of 86%. Conclusion: Since ACR in random urine corresponds well with 24-hour urine protein, using it as a substitute was deemed appropriate. Thus, it can be used as a clinical screening test, benefiting from the fact that the ACR rarely changes significantly throughout the day, more easy and rapid method, not affected by urine concentration. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2D) patients with albuminuria have coronary microvascular dysfunction (CMD). Fractional flow reserve assessed by coronary computed tomography angiography (FFRct) is dependent on the structure and function of the microcirculation and is likely influenced by CMD. We aimed to evaluate if asymptomatic patients with T2D who had no significant coronary artery stenosis but had been diagnosed with albuminuria had lower value of nadir FFRct compared to asymptomatic patients with T2D and no albuminuria. Methods and results: This was a cross-sectional study which compared the mean nadir FFRct values in coronary arteries in patients with T2D who had no symptoms of angina. The T2D patients were divided into two groups (albuminuria and no albuminuria) with albuminuria being defined as albumin–creatinine-ratio (ACR) ≥30 milligram per gram. The nadir FFRct values were compared between the two groups for left anterior descendent artery (FFRct-LAD), circumflex artery (FFRct-CX), and right coronary artery (FFRct-RCA) by using a two-sample Wilcoxon rank-sum (Mann–Whitney) test. Ninety-eight patients without albuminuria and 26 patients with albuminuria were included. No significant differences in mean values were detected for FFRct-CX 0.86 ± 0.07 and 0.88 ± 0.0, FFRct-RCA 0.88 ± 0.05 and 0.88 ± 0.07, or for FFRct-LAD 0.82 ± 0.07 and 0.82 ± 0.07 in patients with albuminuria and without albuminuria, respectively. Conclusion: In this observational study, we did not find that FFRct was affected by CMD. Therefore, it is not a surrogate for microvascular dysfunction in asymptomatic T2D patients with albuminuria.

Diabetic kidney disease (DKD) poses a significant health challenge for individuals with diabetes. At its initial stages, DKD often presents asymptomatically, and the standard for non-invasive diagnosis, the albumin-creatinine ratio (ACR), employs discrete categorizations (normal, microalbuminuria, macroalbuminuria) with limitations in sensitivity and specificity across diverse population cohorts. Single biomarker reliance further restricts the predictive value in clinical settings. Given the escalating prevalence of diabetes, our study uses proteomic technologies to identify novel urinary proteins as supplementary DKD biomarkers. A total of 158 T1D subjects provided urine samples, with 28 (15 DKD; 13 non-DKD) used in the discovery stage and 131 (45 DKD; 40 pDKD; 46 non-DKD) used in the confirmation. We identified eight proteins (A1BG, AMBP, AZGP1, BTD, RBP4, ORM2, GM2A, and PGCP), all of which demonstrated excellent area-under-the-curve (AUC) values (0.959 to 0.995) in distinguishing DKD from non-DKD. Furthermore, this multi-marker panel successfully segregated the most ambiguous group (microalbuminuria) into three distinct clusters, with 80% of subjects aligning either as DKD or non-DKD. The remaining 20% exhibited continued uncertainty. Overall, the use of these candidate urinary proteins allowed for the better classification of DKD and offered potential for significant improvements in the early identification of DKD in T1D populations. [Display omitted] • A total of 908 unique proteins were identified in all urine samples. • 227 urine proteins showed significant differences between the DKD group and the non-DKD group. • 8 proteins demonstrated excellent AUC values (0.959 to 0.995) in distinguishing DKD from non-DKD. • The urinary protein panel allowed for improved classification of T1D patients into DKD or non-DKD. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR) is a microvascular complication as a consequence of prolonged hyperglycemia and other risk factors. It is seen in both types of diabetes mellitus (DM) and can lead to progressive vision loss. Many prevalence studies were undertaken in the past, but the eastern part of India was less explored. Aim: (1) The aim of this study is to determine the prevalence of DR among both types of DM patients in an institution-based population of Kolkata. (2) To compare the clinic-biochemical profiles of patients with and without DR. Materials and Methods: From January 2019 to December 2019, 313 patients with a history of DM were screened for DR using slit-lamp bio microscopy with +90D lens after dilating the pupils. Classification of DR was done on the basis of International Clinical classification of DR. Metabolic profile of all participants was noted. Results: The overall prevalence of DR was 16.60% (14.37% nonproliferative and 2.23% proliferative). The prevalence was 80% and 15.58% among Type 1 and 2 DM patients, respectively. Diabetic macular edema was observed in 2.54% of cases. Highest prevalence (38.46%) was observed in patients suffering for more than 20 years of DM. The duration of DM was significantly higher among DR patients (9.46 ± 5.23 years vs. 7.34 ± 5.57; P = 0.012). Patients with DR also displayed significantly higher levels of glycated hemoglobin, creatinine, and albumin-creatinine ratio in comparison to the patients without DR. Conclusion: The prevalence of DR from an institution of Eastern India is comparable to other institutional studies conducted in the various parts of the country. The prevalence is higher among Type 1 DM patients. Nonproliferative DR is the most common type. Comparatively, DR patients had a longer duration of DM. Glycemic control and renal statuses are poor in DR than non-DR patients.

We investigated 180 consecutive patients with congestive heart failure (CHF), of whom 83 had type 2 diabetes (T2DM) and 97 did not have diabetes as well as 223 controls without CHF, of whom 39 had T2DM and 184 did not have diabetes. Data was recorded by standardized interviews and by standardized examination protocols at our institution and were extracted from medical records. Here, we analyzed data on gender differences. Further, we examined the effect of CHF and T2DM on moderate albuminuria, i.e. on an albumin-creatinine ratio (ACR) of 30–300 mg/g. Table 1 shows baseline characteristics of our patients stratified by gender. Table 2 gives ACRs and prevalence rates of albuminuria separately for men and women.In logistic regression analyses adjusting for age, sex, body mass index, LDL cholesterol, history of smoking, history of hypertension, use of statins, ACE inhibitors/angiotensin II receptor blockers, aldosterone antagonists and other antihypertensive medication CHF and T2DM predicted the prevalence of albuminuria in a mutually independent manner in men (OR 4.93 [95% CI 1.76–13.85]; p = 0.002 and OR 2.38 [1.11–5.11]; p = 0.027, respectively), as well as in women (OR 5.66 [95% CI 1.76–18.20]; p = 0.004 and OR 3.53 [1.38–9.08]; p = 0.009, respectively). There was no significant interaction between gender and CHF or T2DM regarding the presence of albuminuria (p = 0.933 and 0.533, respectively), indicating that the association of CHF and T2DM with albuminuria did not differ significantly between men and women.In multivariate analysis of covariance, CHF and T2DM proved to be independent predictors of ACR in women after adjustment for age, sex, body mass index, LDL cholesterol, history of smoking, history of hypertension, use of statins, ACE inhibitors/angiotensin II receptor blockers, aldosterone antagonists and other antihypertensive medication (F = 5.38; p = 0.022 and F = 4.95; p = 0.028, respectively); for men the corresponding F-values were 2.70; p = 0.102 and 3.12; p = 0.079, respectively. There was no significant interaction between gender and CHF or T2DM regarding ACR (p = 0.464 and 0.202, respectively), indicating that the association of CHF and T2DM with the ACR did not differ significantly between men and women.Regarding moderate albuminuria, both CHF and T2DM predicted moderate albuminuria adjusted in a mutually independent manner after the adjustments described above, with ORs of 4.75 [95% CI 2.16–10.45]; p

Background: Diabetic kidney disease (DKD) is a leading risk factor for end-stage renal disease and is one of the most important risk factors for cardiovascular disease in patients with diabetes. It is possible that novel markers portraying the pathophysiological underpinning processes may be useful. Aim: To investigate the associations between 80 circulating proteins, measured by a proximity extension assay, and prevalent DKD and major adverse cardiovascular events (MACE) in type 2 diabetes. Methods: We randomly divided individuals with type 2 diabetes from three cohorts into a two-thirds discovery and one-third replication set (total n = 813, of whom 231 had DKD defined by estimated glomerular filtration rate

Background: Diabetic retinopathy (DR) is a microvascular complication as a consequence of prolonged hyperglycemia and other risk factors. It is seen in both types of diabetes mellitus (DM) and can lead to progressive vision loss. Many prevalence studies were undertaken in the past, but the eastern part of India was less explored. Aim: (1) The aim of this study is to determine the prevalence of DR among both types of DM patients in an institution-based population of Kolkata. (2) To compare the clinic-biochemical profiles of patients with and without DR. Materials and Methods: From January 2019 to December 2019, 313 patients with a history of DM were screened for DR using slit-lamp bio microscopy with +90D lens after dilating the pupils. Classification of DR was done on the basis of International Clinical classification of DR. Metabolic profile of all participants was noted. Results: The overall prevalence of DR was 16.60% (14.37% nonproliferative and 2.23% proliferative). The prevalence was 80% and 15.58% among Type 1 and 2 DM patients, respectively. Diabetic macular edema was observed in 2.54% of cases. Highest prevalence (38.46%) was observed in patients suffering for more than 20 years of DM. The duration of DM was significantly higher among DR patients (9.46 ± 5.23 years vs. 7.34 ± 5.57; P = 0.012). Patients with DR also displayed significantly higher levels of glycated hemoglobin, creatinine, and albumin-creatinine ratio in comparison to the patients without DR. Conclusion: The prevalence of DR from an institution of Eastern India is comparable to other institutional studies conducted in the various parts of the country. The prevalence is higher among Type 1 DM patients. Nonproliferative DR is the most common type. Comparatively, DR patients had a longer duration of DM. Glycemic control and renal statuses are poor in DR than non-DR patients. [ABSTRACT FROM AUTHOR]

BackgroundAcute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white).Study designCollaborative meta-analysis.Setting & population8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants).Selection criteria for studiesAvailable eGFR, ACR, and 50 or more AKI events.PredictorsAge, sex, race, eGFR, urine ACR, and interactions.OutcomeHospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.Results16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR.LimitationsOnly 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code.ConclusionsReduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.

BackgroundAPOL1 genotype is associated with advanced kidney disease in African Americans, but the pathogenic mechanisms are unclear. Here, associations of APOL1 genotype with urine biomarkers of glomerular and tubular injury and kidney function decline were evaluated.Study designObservational study.Setting & participants431 human immunodeficiency virus (HIV)-infected African American women enrolled in Women's Interagency HIV Study (WIHS).PredictorAPOL1 genotype.OutcomesAlbumin-creatinine ratio (ACR), 4 tubular injury biomarkers (interleukin 18 [IL-18], kidney injury molecule 1 [KIM-1], neutrophil gelatinase-associated lipocalin [NGAL], and α1-microglobulin [A1M]), and kidney function estimated using the CKD-EPI cystatin C equation.MeasurementsParticipants were genotyped for APOL1 single-nucleotide polymorphisms rs73885319 (G1 allele) and rs71785313 (G2 allele). Urine biomarkers were measured using stored samples from 1999-2000. Cystatin C was measured using serum collected at baseline and 4- and 8-year follow-ups.ResultsAt baseline, ACRs were higher among 47 women with 2 APOL1 risk alleles versus 384 women with 0/1 risk allele (median, 24 vs 11mg/g; P30 (95% CI, 1.17-3.44) mg/g after multivariable adjustment. APOL1 genotype showed little association with urine IL-18:Cr ratio, KIM-1:Cr ratio, and NGAL:Cr ratio (estimates of -5% [95% CI, -24% to 18%], -20% [95% CI, -36% to -1%], and 10% [95% CI, -26% to 64%], respectively) or detectable urine A1M (prevalence ratio, 1.13; 95% CI, 0.65-1.97) in adjusted analyses. Compared with women with 0/1 allele, women with 2 risk alleles had faster eGFR decline, by 1.2 (95% CI, 0.2 to 2.2) mL/min/1.73m(2) per year, and 1.7- and 3.4-fold greater rates of incident chronic kidney disease (95% CI, 1.1 to 2.5) and 10% annual eGFR decline (95% CI, 1.7 to 6.7), respectively, with minimal attenuation after adjustment for glomerular and tubular injury biomarker levels.LimitationsResults may not be generalizable to men.ConclusionsAmong HIV-infected African American women, APOL1-associated kidney injury appears to localize to the glomerulus, rather than the tubules.

BackgroundLow ankle-brachial index (ABI) is a reflection of atherosclerotic disease, and high ABI is an indicator of calcified vessels. The associations of albuminuria and cystatin C level with incidence of either low or high ABI are unknown.Study designProspective longitudinal cohort study.Setting & participantsMESA (Multi-Ethnic Study of Atherosclerosis) enrolled community-dwelling adults (N=6,814) aged 45-84 years who were free of clinical cardiovascular disease at baseline.PredictorsBaseline albumin-creatinine ratio (ACR) and serum cystatin C level.OutcomesDevelopment of low (1.40) ABI using multinomial regression among persons with ABI of 0.90-1.40 at baseline.ResultsDuring 9.8 years of follow-up, 221 and 89 participants progressed to low and high ABIs, respectively. Baseline ACR and cystatin C level were higher among progressors compared with nonprogressors. In multivariable analyses, doubling of ACR was associated with increased risk of progression to low (OR, 1.08; 95% CI, 0.99-1.20) and high (OR, 1.16; 95% CI, 1.01-1.32) ABIs. Compared to the lowest quintile, the highest quintile of ACR had a significantly increased risk of progression to low (OR, 1.79; 95% CI, 1.03-3.12) and high (OR, 2.76; 95% CI, 1.32-5.77) ABIs. Higher cystatin C levels were associated with progression to low (OR per 1-SD greater, 1.12; 95% CI, 1.00-1.26) but not high (OR per 1-SD greater, 1.01; 95% CI, 0.81-1.25) ABI, but the highest quintile of cystatin C was not associated independently with either outcome.LimitationsSingle measure of albuminuria and low number of progressors to high ABI.ConclusionsIn adults free of clinical cardiovascular disease, albuminuria was a strong independent risk factor for the development of both high and low ABIs, important and different measures of peripheral artery disease.

Context: Postoperative acute kidney injury (AKI) is associated with increased morbidity and mortality in patients undergoing cardiac surgery. Aim: The aim of the present study is to compare preoperative and postoperative serum albumin levels, urine albumin–creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) in patients undergoing cardiac surgery as a predictor of AKI. Settings and Design: The prospective study was conducted at cardiothoracic unit in the individuals of age 40–70 years admitted for coronary artery bypass grafting. Materials and Methods: The study participants admitted for cardiac surgery with normal serum creatinine value of 0.3–1.3 mg/dl were included. Preoperative and postoperatively (days 1 and 3 after cardiac surgery) parameters such as serum albumin, creatinine, and UACR were analyzed. Baseline serum creatinine >1.6 mg/dl was excluded. eGFR was calculated with Cockcroft's formula and categorized as Group A with eGFR <60 ml/min and Group B with eGFR ≥60 ml/min. Results: Mean UACR compared to baseline was found to be increased progressively on day 1 and day 3 postoperative period after cardiac surgery. Compared with baseline data, albumin levels were found to be decreased during postoperative phase. eGFR reflected the risk of kidney damage as it gets decreased by 15% on day 1 after cardiac surgery. Receiver operating characteristic curve analysis of albumin and UACR revealed sensitivity and specificity that predicts lowered eGFR. Conclusion: Decreased serum albumin and increased UACR after cardiac surgery reflected with lowered eGFR indicate the renal injury after cardiac surgery. Serum hypoalbuminemia and UACR are predictors of AKI in the postoperative phase. [ABSTRACT FROM AUTHOR]

Objective: Although renal impairments are observed in patients with primary aldosteronism (PA), the association between plasma aldosterone concentration (PAC) and specific structural kidney damage remains unknown. Thus, we analysed the association between PAC, and markers of glomerular and tubular damage. Design: This was a retrospective cross‐sectional study of 96 PA patients, in which we analysed the association between PAC and markers of kidney damage, including urinary albumin‐creatinine ratio (ACR) for glomerular damage, and urinary liver fatty acid‐binding protein (L‐FABP), N‐acetyl‐β‐D‐glucosaminidase (NAG) and β2‐microglobulin (β2‐MG) for tubular damage. In addition, we evaluated the association between PAC and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) as a marker for body fluid volume. Results: Urinary ACR, L‐FABP, NAG, β2‐MG and NT‐proBNP significantly correlated with PAC. PAC (<415 pmol/L, 415‐550, 550‐740, 740 <)‐based quartile analysis revealed that both elevated markers of kidney damage and NT‐proBNP could be observed in PA patients with a PAC over 550 pmol/L. Logistic regression analysis showed that PAC was significantly associated with a risk of both microalbuminuria and lowered eGFR (<60 mL/min/1.73 m2), with its optimal cut‐offs for predicting each, 558 and 594 pmol/L, respectively. Conclusions: Increased PAC, especially over 550 pmol/L, is associated with excessive damage to the tubule and glomerulus. [ABSTRACT FROM AUTHOR]

Decrease in blood pressure contributes to the reno-protective effects of sodium-glucose cotransporter 2 inhibitors; however, its relationship with home monitoring of blood pressure is unclear. We retrospectively analyzed 101 visiting members of the Kanagawa Physicians Association with type 2 diabetes mellitus and chronic kidney disease who were taking sodium-glucose cotransporter 2 inhibitors and who monitored blood pressure at home for a median treatment period of 14 months. At baseline, the mean value of HbA1c was 59.3 mmol/mol (7.6%) and the median value of albumin-creatinine ratio was 30.9 mg/gCr that was evaluated in 88 patients. The mean blood pressure both at office and home significantly decreased, and there was a significant positive correlation between the change in albumin–creatinine ratio and both blood pressures. Controlled hypertension, masked hypertension, white coat hypertension, and sustained hypertension were observed in 10.9%, 13.9%, 12.9%, and 62.4% of patients at the initiation of therapy, which changed to 10.9%, 16.8%, 17.8%, and 54.5% at the time of the survey, respectively. In conclusion, management of blood pressure both at office and home was found to be important for the reno-protective effects of sodium-glucose cotransporter 2 inhibitors along with strict blood pressure management.

Background: Helicobacter pylori (H. pylori) is relevant to several renal diseases. Our previous research indicates that cytotoxin-associated gene A (CagA) of H. pylori increases secretion of serum immunoglobulin A1 (IgA1) and induces the underglycosylation of IgA1, one of the key factors causing IgA nephropathy. Here, we aimed to study the correlation between H. pylori infection and kidney damage in patients with peptic ulcer, and evaluate the effect of H. pylori eradication on kidney damage. Methods: 14C-urea breath test and rapid urease tests were applied to H. pylori infection detection. Random urine samples are subjected to the albumin–creatinine ratio (ACR) examination. The correlation between ACR and H. pylori infection was analyzed in patients with peptic ulcer and healthy controls. The levels of IgA and underglycosylated IgA1 in serum are also detected by enzyme-linked immunosorbent assay (ELISA) and Helix aspersa lectin (HAA) binding assay. Results: (1) H. pylori infection rate in patients with peptic ulcer (88.14%) is significantly higher than that in healthy controls (42.68%). (2) There is a positive correlation between H. pylori infection and ACR abnormal in patients with peptic ulcer (p = .025), while showing a negative correlation in healthy individuals (p = .571). (3) Urinary ACR was uncorrelated with the severity of H. pylori infection in the 27 abnormal urinary ACR cases of the patients with peptic ulcer. (4) After H. pylori eradication, the ACR rates of H. pylori-positive patients with peptic ulcer were significantly decreased (p

Background: Diabetic kidney disease (DKD) is a leading risk factor for end-stage renal disease and is one of the most important risk factors for cardiovascular disease in patients with diabetes. It is possible that novel markers portraying the pathophysiological underpinning processes may be useful. Aim: To investigate the associations between 80 circulating proteins, measured by a proximity extension assay, and prevalent DKD and major adverse cardiovascular events (MACE) in type 2 diabetes. Methods: We randomly divided individuals with type 2 diabetes from three cohorts into a two-thirds discovery and one-third replication set (total n = 813, of whom 231 had DKD defined by estimated glomerular filtration rate <60 mg/mL/1.73 m2 and/or urinary albumin-creatinine ratio ≥3 g/mol). Proteins associated with DKD were also assessed as predictors for incident major adverse cardiovascular events (MACE) in persons with DKD at baseline. Results: Four proteins were positively associated with DKD in models adjusted for age, sex, cardiovascular risk factors, glucose control, and diabetes medication: kidney injury molecule-1 (KIM-1, odds ratio [OR] per standard deviation increment, 1.65, 95% confidence interval [CI] 1.27–2.14); growth differentiation factor 15 (GDF-15, OR 1.40, 95% CI 1.16–1.69); myoglobin (OR 1.57, 95% CI 1.30–1.91), and matrix metalloproteinase 10 (MMP-10, OR 1.43, 95% CI 1.17–1.74). In patients with DKD, GDF-15 was significantly associated with increased risk of MACE after adjustments for baseline age, sex, microalbuminuria, and kidney function and (59 MACE events during 7 years follow-up, hazard ratio per standard deviation increase 1.43 [95% CI 1.03–1.98]) but not after further adjustments for cardiovascular risk factors. Conclusion: Our proteomics approach confirms and extends previous associations of higher circulating levels of GDF-15 with both micro- and macrovascular disease in patients with type 2 diabetes. Our data encourage additional studies evaluating the clinical utility of our findings. [ABSTRACT FROM AUTHOR]

Background:Helicobacter pylori (H. pylori) is relevant to several renal diseases. Our previous research indicates that cytotoxin-associated gene A (CagA) of H. pylori increases secretion of serum immunoglobulin A1 (IgA1) and induces the underglycosylation of IgA1, one of the key factors causing IgA nephropathy. Here, we aimed to study the correlation between H. pylori infection and kidney damage in patients with peptic ulcer, and evaluate the effect of H. pylori eradication on kidney damage. Methods:14C-urea breath test and rapid urease tests were applied to H. pylori infection detection. Random urine samples are subjected to the albumin–creatinine ratio (ACR) examination. The correlation between ACR and H. pylori infection was analyzed in patients with peptic ulcer and healthy controls. The levels of IgA and underglycosylated IgA1 in serum are also detected by enzyme-linked immunosorbent assay (ELISA) and Helix aspersa lectin (HAA) binding assay. Results: (1) H. pylori infection rate in patients with peptic ulcer (88.14%) is significantly higher than that in healthy controls (42.68%). (2) There is a positive correlation between H. pylori infection and ACR abnormal in patients with peptic ulcer (p =.025), while showing a negative correlation in healthy individuals (p =.571). (3) Urinary ACR was uncorrelated with the severity of H. pylori infection in the 27 abnormal urinary ACR cases of the patients with peptic ulcer. (4) After H. pylori eradication, the ACR rates of H. pylori-positive patients with peptic ulcer were significantly decreased (p<.01). Conclusions: (1) For the H. pylori-positive patients with peptic ulcer, H. pylori infection may be a risk factor resulting in kidney damage. (2) H. pylori eradication probably benefits to kidney damage relief and chronic kidney disease prevention. [ABSTRACT FROM AUTHOR]

Introduction: Albuminuria is prevalent in patients with chronic heart failure and is a risk factor for disease progression. However, its clinical meaning in acute heart failure remains elusive. This study analyzed the trajectory of urine albumin to creatinine ratio (UACR) between admission and discharge and its association with decongestion., Methods: In this prospective observational study, 63 patients were enrolled. UACR, B-type natriuretic peptide (BNP), and clinical congestion score (CCS) were obtained at admission and discharge. We used linear mixed regression analysis to compare changes in the natural logarithm of UACR (logUACR) and its association with changes in markers of decongestion. Estimates were reported as least squares mean with their respective 95% CIs., Results: The median age of the study population was 87 years, 68.5% were women, and 69.8% had a left ventricular ejection fraction &gt;50%. LogUACR at discharge significantly decreased in the overall population compared to admission (Δ -0.47, 95% CI: -0.78 to -0.15, p value = 0.003). The magnitude of UACR drop at discharge was associated with changes in surrogate markers of decongestion. Patients who showed a greater reduction in BNP at discharge exhibited a greater reduction in UACR (p = 0.016). The same trend was also found with clinical decongestion, as assessed by changes in CCS, however, without achieving statistical significance (p = 0.171). UACR change at discharge was not associated with changes in serum creatinine (p value = 0.923)., Conclusion: In elderly patients with AHF and volume overload, the level of UACR significantly decreased upon discharge compared to admission. This reduction in UACR was closely linked to decreases in BNP., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Background Albuminuria is a known marker of mortality risk. Whether the association between albuminuria and mortality differs by demographic and comorbidity factors remains unclear. Therefore, we sought to determine whether albuminuria is differentially associated with mortality. Methods and Results This study included 49 640 participants from the National Health and Nutrition Examination Survey (1999-2018). All-cause mortality through 2019 was linked from the National Death Index. Multivariable-adjusted Poisson regression models were used to determine whether levels of urine albumin-to-creatinine ratio (ACR) were associated with mortality. Models were adjusted for demographic, socioeconomic, behavioral, and clinical factors. Mean age in the population was 46 years, with 51.3% female, and 30.3% with an ACR ≥10 mg/g. Over a median follow-up of 9.5 years, 6813 deaths occurred. Compared with ACR <10, ACR ≥300 was associated with increased risk of mortality by 132% overall (95% CI, 2.01-2.68), 124% among men (95% CI, 1.84-2.73), 158% among women (95% CI, 2.14-3.11), 130% among non-Hispanic White adults (95% CI: 1.89-2.79), 135% among non-Hispanic Black adults (95% CI, 1.82-3.04), and 114% among Hispanic adults (95% CI, 1.55-2.94). Compared with ACR <10, ACR ≥300 was associated with increased risk of mortality by 148% among individuals with neither hypertension nor hypercholesterolemia (95% CI, 1.69-3.64), 128% among individuals with hypertension alone (95% CI, 1.86-2.79), and 166% among individuals with both hypertension and hypercholesterolemia (95% CI, 2.18-3.26). Conclusions We found strong associations between albuminuria and mortality risk, even at mildly increased levels of albuminuria. Associations persisted across categories of sex, race or ethnicity, and comorbid conditions, with subtle differences.

Decrease in blood pressure contributes to the reno-protective effects of sodium-glucose cotransporter 2 inhibitors; however, its relationship with home monitoring of blood pressure is unclear. We retrospectively analyzed 101 visiting members of the Kanagawa Physicians Association with type 2 diabetes mellitus and chronic kidney disease who were taking sodium-glucose cotransporter 2 inhibitors and who monitored blood pressure at home for a median treatment period of 14 months. At baseline, the mean value of HbA1c was 59.3 mmol/mol (7.6%) and the median value of albumin-creatinine ratio was 30.9 mg/gCr that was evaluated in 88 patients. The mean blood pressure both at office and home significantly decreased, and there was a significant positive correlation between the change in albumin–creatinine ratio and both blood pressures. Controlled hypertension, masked hypertension, white coat hypertension, and sustained hypertension were observed in 10.9%, 13.9%, 12.9%, and 62.4% of patients at the initiation of therapy, which changed to 10.9%, 16.8%, 17.8%, and 54.5% at the time of the survey, respectively. In conclusion, management of blood pressure both at office and home was found to be important for the reno-protective effects of sodium-glucose cotransporter 2 inhibitors along with strict blood pressure management. [ABSTRACT FROM AUTHOR]

The albumin-creatinine ratio is considered an indicator of microalbuminuria, precursor to chronic kidney disease, while HbA1c is used to measure glycemic control. Given the prevalence of diabetesrelated nephropathy, spot testing of albumin has long been recommended as a preventative measure, for the timely detection of microalbuminuria. However, many countries do not have this testing available in primary care, and sometimes not even in second- and third-level care. The objective of this study was to compare agreement of the microalbuminuria and HbA1c results obtained in the laboratory with ‘gold standard’ techniques, with those obtained on site with a ‘Point of Care’ DCA VantageTM device by Siemens. Results for the albumin–creatinine ratio and HbA1c from the Siemens DCA VantageTM point of care device were compared with those from standard laboratory tests in 25 family medicine units in Mexico City and Toluca, State of Mexico, in patients diagnosed with type-2 diabetes. Agreement between the albumin values of the 2 tests was 0.745 (CI 95% 0.655–0.812). Agreement between the two measurement techniques for HbA1c was 0.970 (CI 95% 0.966–0.973). The results obtained were sufficiently comparative (Ri=0.74 for albumin-creatinine ratio and Ri=0.97 for HbA1c) to justify the use of the point of care device. Given the high agreement between the point of care device and laboratory tests, this device could be used to identify chronic kidney disease and glycemic control for more adequate treatment in patients with diabetes, especially in remote areas. [ABSTRACT FROM AUTHOR]

Background Conflicting evidence exists regarding whether reduced estimated glomerular filtration rate (eGFR) and proteinuria are independent risk factors for stroke and its subtypes in hypertensive patients. This study investigated the association of these renal measures with first incident stroke in adults under treatment for hypertension in China. Methods and Results The study included 19 599 adults aged 45 to 75 years who participated in the China Stroke Primary Prevention Trial. Baseline eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Proteinuria was assessed by qualitative dipstick urinalysis and in a subset by the quantitative albumin–creatinine ratio method. Cox regression analysis was used to examine the effects of eGFR and proteinuria on the risk of first incident stroke. During a median of 4.5 years of follow‐up, a total of 585 first strokes (472 ischemic strokes) were identified. Compared to participants without proteinuria, participants with proteinuria (trace or more by dipstick) had a 35% increased risk of first stroke: the adjusted hazard ratio (HR) (95% CI) was 1.35 (1.09–1.66, P=0.005). The results were robust in subgroup analyses. In a subset with data on proteinuria measured by quantitative albumin–creatinine ratio, a similar association was found. In both independent and combined analyses with proteinuria, eGFR was not significantly associated with stroke. Conclusions In adults under treatment for hypertension in China, baseline proteinuria measured by dipstick or quantitative albumin–creatinine ratio, but not reduced eGFR, was found to be an independent risk factor for first incident stroke and ischemic stroke.

Objective To establish albumin-creatinine ratio (ACR) reference value of the rural population in Hebei province. Methods This study enrolled 5154 participants. By excluding subjects with hypertension, diabetes, dyslipidemia, cardiovascular and cerebrovascular diseases, kidney diseases, and overweight condition, as well as those with an estimated glomerular filtration rate (eGFR) < 60 ml/(min·1.73 m 2 ), apparently healthy subjects (1168) were selected. Urine albumin was measured by using the immunoturbidimetic method, serum creatinine was measured by using Jaffe's kinetic method on a morning spot-urine sample, and ACR was calculated. The 95th percentile of ACR in the healthy subjects was used as the normal upper limit. Results The normal upper limit of ACR was 28.71 mg/g (3.25 mg/mmol) for males and 31.85 mg/g (3.60 mg/mmol) for females. Based on this ACR reference value, the age-gender standardized prevalence of albuminuria in the rural areas of Hebei province was 12.9%. Conclusion The ACR reference value in the rural of Hebei province is higher than that of the Western population. [ABSTRACT FROM AUTHOR]

Background: The role of uric acid in development of renal dysfunction (RD) remains controversial. Earlier studies have reported inconsistent results, possibly because of their varying ability to adjust for confounding. The impact of longitudinal change in uric acid on renal outcome has not been assessed previously. We aimed to study the impact of change in serum uric acid (SUA) as well as baseline SUA on the development of RD.Methods: In a prospective cohort study, we assessed the associations between change in SUA during follow-up, baseline SUA and RD (defined as albumin-creatinine-ratio (ACR) ≥1.13 mg albumin/mmol creatinine and/or eGFR < 60 ml/min/1.73 m(2)) in a large cohort from a general population participating in the Tromsø Study (n = 2637). Participants were stratified according to tertiles of change in SUA between baseline (1994/95) and follow-up 13 years later. (upper tertile: SUA increasing group, two lower tertiles: SUA non-increasing group). Logistic regression analysis was applied with RD and each component of RD after 7 and 13 years as the dependent variables. Adjustments were made for baseline eGFR, cardiovascular risk factors, and the use of antihypertensive drugs including diuretics.Results: After excluding participants with RD at baseline, SUA increasers, compared to SUA non-increasers, had a doubled risk of RD after 7 years (odds ratio 2.00, (95 % CI 1.45, 2.75)). Odds ratio for RD in SUA increasers after 13 years was 2.18 (95 % CI 1.71, 2.79). The risk of developing ACR ≥1.13 mg/mmol alone was not significantly increased after 7 years (odds ratio 1.30 (95 % CI 0.90, 1.89), but after 13 years (odds ratio 1.43 (95 % CI 1.09, 1.86)). An increase in baseline SUA of 59 μmol/L (1 mg/dL) gave an odds ratio for RD after 13 years of 1.16 (95 % CI 1.04, 1.29).Conclusion: An increase in SUA during follow-up was associated with an increased risk of developing RD after 7 and 13 years. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Microalbuminuria (MA) is a well-known risk factor for coronary artery disease (CAD). It is associated with higher cardiovascular mortality, especially in diabetics. However, there are few data linking angiographic severity of CAD to MA. Aim: The aim of the present study was to assess the albumin to creatinine ratio as a new predictor for CAD and to correlate with its severity apart from other traditional CAD risk factors. Methods: Our study included 100 patients with documented CAD by coronary angiography in Alexandria main university hospital. The severity of CAD was scored on the basis of the number and the extent of lesions within the coronary arteries by using Syntax score. Urine albumin excretion was measured for all patients in morning spot urine samples by immune precipitation technique. We correlate between MA and severity of CAD. Results: In a total of 100 patients (74 males and 26 females), (mean age 55.71±8.99 y) MA was present in 34 patients only. Patients were divided into two groups; group I included those without MA and group II with MA. CAD occurred more frequently in males than in females and in smokers than in non-smokers. There were no significant differences in the prevalence of hypertension and hypercholesterolemia between the two groups. A direct relationship between MA and extension of atherosclerotic coronary lesions was noticed (P =0.009). Conclusion: Patients with MA having more severe angiographic CAD were compared to those without MA. This relation is independent of other risk factors. MA could be utilized as an independent risk factor for CAD. [Copyright &y& Elsevier]

Abstract: Aims: To determine whether protein–creatinine ratio (PCR) and albumin–creatinine ratio (ACR) are comparable to 24h urine protein in terms of agreement and repeatability, and therefore whether they are suitable for monitoring and comparing reduction in proteinuria in clinical trials of endothelin receptor antagonists. Main methods: Using data from a recent study of sitaxentan in 27 patients with proteinuric chronic kidney disease, the assays were compared with reference to their agreement, repeatability, the number of measurements required to obtain accurate results and correlation with reduction in proteinuria at baseline. Key findings: The median coefficient of variation was lower for PCR than 24h urine protein (25 vs. 28%) but the range was higher (70 vs. 47%). When converted into the same units, mean difference between 24h urine protein and both PCR (0.03g/day), and ACR (0.10g/day), was small. However, scatter increased with mean level of proteinuria, such that agreement fell substantially above 1.5g/day. According to 2-factor within-subjects ANOVA, the assay used was not a significant source of variation (PCR p=0.63, ACR p=0.38). With 3 measurements at each time point, baseline proteinuria correlated equally well with change in proteinuria, and percentage change was detected accurately by all 3 methods. Significance: PCR and ACR may well be suitable replacements for 24h urine protein in the clinical trial context due to their similar accuracy and repeatability, greater convenience and lower cost. However, a randomised control trial comparing all 3 assays in a larger and more diverse population is necessary before 24h urine protein can be replaced. [Copyright &y& Elsevier]

Background: Diabetic nephropathy (DN) is a significant cause of hemodialysis, and its early detection is extremely important to prevent or delay end-stage renal disease. The significance of the renal function marker serum cystatin C (sCysC) and its relationship with glomerular filtration rate in chronic kidney disease (CKD) and DN in Japanese patients with type 2 diabetes remains uncertain. In this study, we examined the effectiveness of sCysC as a marker of early DN and CKD in Japanese subjects. Methods: A total of 325 Japanese patients with type 2 diabetes and 88 healthy subjects were studied retrospectively. sCysC concentration (mg/L) was determined by a latex turbidmetric immunoassay using a BioMajesty 8040 analyzer. The renal function of the diabetic patients was evaluated using the albumin-creatinine ratio (ACR) and Kidney Disease Outcome Quality Initiative-Kidney Disease Improving Global Outcomes (K/DOQI-KDIGO) classification. Results: There was a significant increase in sCysC but not in serum creatinine (sCr) or serum β2-microglobulin (sβ2M) in patients with grade 2 DN (ACR 30-300 mg/g) compared to grade 1 patients. Receiver operating characteristic analysis in grade 2 and 3 DN patients showed that sCysC had superior sensitivity and specificity than sCr and sβ2M for early detection of DN. In addition, sCysC showed particularly high sensitivity and specificity in DN patients with stage 2 CKD. Conclusions: sCysC was effective for detection of grade 2 DN and would be especially useful for screening stage 2 CKD patients (K/DOQI-KDIGO). [ABSTRACT FROM AUTHOR]

Aim Diabetes mellitus (DM) is a chronic disease requiring continuous monitoring and treatment. Self-monitoring of blood glucose (SMBG) is frequently recommended. The purpose of the study was to evaluate effectiveness of SMBG on metabolic control in Turkish patients with type 2 DM. Methods The cross-sectional study enrolled type 2 diabetic patients without insulin regimen. The participants were assigned to three groups according to status of SMBG: group 1- regular, group 2 - irregular and group 3 - never SMBG implementation. Results A total of 349 patients were enrolled. There was no significant difference in mean fasting and post-prandial blood glucose, lipid profile values between the groups. The number of patients with high education level in-group 1 was higher than groups 2 and 3 (p = 0.001). HbA1c level was higher in groups 2 and 3 than group 1, but not significantly (p = 0.285). Mean spot urinary albumin-creatinine ratio (ACR) in-group 1 is significantly lower than in groups 2 and 3 (p = 0.008 and p = 0.044, respectively), but no significant difference was observed between group 2 and 3 (p = 0.473). Conclusion The study indicated that regular use of SMBG was not superior to irregular/never use of SMBG on glycemic control, but it seemed to be good intervention for prevention of diabetic nephropathy. We suggestively offered that SMBG should be recommended for patients with a high education level to meet the goal of its use, and it should be incorporated into self-management with effective educational intervention. [ABSTRACT FROM AUTHOR]