Prevalence and associations of microalbuminuria in proteinuria-negative patients with type 2 diabetes in two regional hospitals in Cameroon: a cross-sectional study

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Abstract

Background

Microalbuminuria (MA) is the earliest clinical evidence of diabetic nephropathy, but most patients in sub-Saharan Africa (SSA) only have access to much cheaper dipstick proteinuria as a means to screen for diabetic nephropathy. The aim of this study was to determine the prevalence and associations of MA among proteinuria-negative type 2 diabetic patients in a SSA setting.

Methods

In this cross-sectional study, patients with type 2 diabetes screened negative for dipstick proteinuria in a primary healthcare hospital were assessed. Detection of microalbuminuria was carried out in two steps: qualitative detection using special microalbumin urine strip, and quantitative laboratory measurement and calculation of urinary albumin-to-creatinine ratio (UACR). Microalbuminuria was defined as UACR of 30–300 mg/g.

Results

A total of 162 type 2 diabetic patients were included. Using quantitative assessment, the prevalence of microalbuminuria was 14.2% (95% CI 8.8–19.6) whereas 26.5% (95% CI 19.8–34.0) had microalbuminuria with urine strip. The mean systolic blood pressure (p = 0.032), diastolic blood pressure (p = 0.032) and serum creatinine concentration (p < 0.001) were higher in people with microalbuminuria as compared to those with normoalbuminuria, whereas the mean body mass index (p = 0.046) and mean eGFR (p < 0.001) were lower in the albuminuria group. In multiple linear regression, eGFR (p = 0.001) and serum creatinine concentration (p = 0.003) were independently associated with increased UACR.

Conclusions

One in every seven proteinuria-negative type 2 diabetic patients has microalbuminuria in primary care setting in Cameroon; microalbuminuria is associated with higher systolic and diastolic blood pressure, and declining kidney function. Our results emphasize the urgent need to increase the accessibility to microalbuminuria testing to ensure that all diabetic patients with negative dipstick proteinuria can benefit.

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Most cited references 19

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Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes.

C E Mogensen (1984)

We studied whether microalbuminuria (30 to 140 micrograms of albumin per milliliter) would predict the later development of increased proteinuria and early mortality in Type II diabetics. During 1973, morning urine specimens of diabetic clinic patients 50 to 75 years of age whose disease had been diagnosed the age of 45 were examined for albumin level by radioimmunoassay. Seventy-six patients with albumin concentrations of 30 to 140 micrograms per milliliter were identified for long-term follow-up. They were compared with normal controls, diabetic patients with lower albumin concentrations (75 patients with concentrations less than 15 micrograms per milliliter and 53 with concentrations of 16 to 29 micrograms per milliliter), and 28 diabetic patients with higher concentrations (greater than 140). Age, duration of diabetes, treatment method, fasting blood glucose level, blood pressure, height, and weight were determined for the four diabetic groups. After nine years the group with albumin concentrations of 30 to 140 micrograms per milliliter was more likely to have clinically detectable proteinuria (greater than 400 micrograms per milliliter) than were the groups with lower concentrations. Mortality was 148 per cent higher in this group than in normal controls--comparable to the increase (116 per cent) in the group with heavy proteinuria (albumin levels greater than 140 micrograms per milliliter). In addition, mortality was increased 76 per cent in the group with albumin levels of 16 to 29 micrograms per milliliter and 37 per cent in the group with levels below 15. We conclude that microalbuminuria in patients with Type II diabetes is predictive of clinical proteinuria and increased mortality.

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Kidney Disease and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Ian H. de Boer, (2013)

OBJECTIVE Kidney disease manifests clinically as elevated albumin excretion rate (AER), impaired glomerular filtration rate (GFR), or both, and is a cause of substantial morbidity and mortality in type 1 diabetes (T1D). The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study tested whether intensive diabetes therapy (INT) aimed at lowering glucose concentrations as close as safely possible to the normal range reduces the risks of kidney disease and other diabetes complications. RESEARCH DESIGN AND METHODS In the DCCT, 1,441 participants with T1D were randomly assigned to INT or conventional diabetes therapy (CON) for a mean duration of 6.5 years. Subsequently, participants have been followed for 18 years in the ongoing observational EDIC. Standardized longitudinal measurements of AER, estimated GFR, and blood pressure were made throughout the DCCT/EDIC. RESULTS During the DCCT, INT reduced the risks of incident microalbuminuria (AER ≥40 mg/24 h) and macroalbuminuria (AER ≥300 mg/24 h) by 39% (95% CI 21–52%) and 54% (29–74%), respectively. During EDIC years 1–8, participants previously assigned to DCCT INT continued to experience lower rates of incident microalbuminuria and macroalbuminuria, with risk reductions of 59% (39–73%) and 84% (67–92%), respectively. Beneficial effects of INT on the development of impaired GFR (sustained estimated GFR <60 mL/min/1.73 m2) and hypertension became evident during combined DCCT/EDIC follow-up, with risk reductions of 50% (18–69%) and 20% (6–21%), respectively, compared with CON. CONCLUSIONS In the DCCT/EDIC, INT resulted in clinically important, durable reductions in the risks of microalbuminuria, macroalbuminuria, impaired GFR, and hypertension.

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The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus.

John Klein, Marina Klein, S Moss … (2000)

Despite the numerous studies on the relation of albuminuria with increased risk of all-cause mortality in type 2 diabetes mellitus, it remains uncertain whether microalbuminuria and/or gross proteinuria are independent risk factors for cardiovascular mortality. Moreover, the association of albuminuria with cardiovascular mortality in people with type 2 diabetes mellitus has not been well described in US populations. To estimate the relative risks (RRs) for the associations of microalbuminuria and gross proteinuria with cardiovascular disease mortality among persons with older-onset diabetes mellitus. We conducted a prospective cohort study of 840 people with older-onset diabetes mellitus who provided urine samples in the 1984-1986 examination of a population-based study of diabetic persons. The presence of microalbuminuria was determined by an agglutination inhibition assay and gross proteinuria by a reagent strip. The main outcome was time to mortality from cardiovascular disease, as determined from death certificates. Of the 840 older-onset diabetic persons, 54.8% had normoalbuminuria, while 24.8% had microalbuminuria and 20.5% had gross proteinuria. During the 12-year follow-up (6127 person-years), we identified 364 deaths from cardiovascular disease. Compared with persons with normoalbuminuria, those with microalbuminuria and gross proteinuria had significantly higher risks of cardiovascular mortality. The RR as controlled for age, sex, glycemic control, insulin use, alcohol intake, physical activity, cardiovascular disease history, antihypertensive use, and retinopathy severity, was 1.84 (95% confidence interval [CI], 1.42-2.40) for those with microalbuminuria and 2.61 (95% CI, 1.99-3.43) for those with gross proteinuria. Further adjustment for other factors did not change the relations we found. When the end point used was mortality from coronary heart disease, stroke, or all causes, the increased risks were significant for both microalbuminuria (adjusted RRs [95% CIs], 1.96 [1.42-2.72], 2.20 [1.29-3.75], and 1.68 [1.35-2.09], respectively) and gross proteinuria (adjusted RRs [95% CIs], 2.73 [1.95-3.81], 2.33 [1.28-4.24], and 2.47 [1.97-3.10], respectively). Results from our population-based study strongly suggest that both microalbuminuria and gross proteinuria were significantly associated with subsequent mortality from all causes and from cardiovascular, cerebrovascular, and coronary heart diseases. These associations were independent of known cardiovascular risk factors and diabetes-related variables.

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Author and article information

Contributors

Nelsy T. Efundem: nelsytaboko@yahoo.com

Jules Clement N. Assob: juleclement@yahoo.fr

Vitalis F. Feteh: vitalfeteh@gmail.com

Simeon-Pierre Choukem: +237 694 849129 , schoukem@gmail.com

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 12 September 2017

Publication date PMC-release: 12 September 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 477

Affiliations

[1 ]ISNI 0000 0001 2288 3199, GRID grid.29273.3d, Department of Medical Laboratory Science, Faculty of Health Sciences, , University of Buea, ; Buea, Cameroon

[2 ]Health and Human Development (2HD) Research Network, Douala, Cameroon

[3 ]ISNI 0000 0001 2288 3199, GRID grid.29273.3d, Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, , University of Buea, ; Buea, Cameroon

[4 ]Diabetes and Endocrine Unit, Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon

Article

Publisher ID: 2804

DOI: 10.1186/s13104-017-2804-5

PMC ID: 5596913

PubMed ID: 28899432

SO-VID: a734820a-c1c6-48f6-add8-54d91baa8524

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 September 2016

Date accepted : 7 September 2017

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ScienceOpen disciplines: Medicine

Keywords: microalbuminuria,diabetes,diabetic nephropathy,glomerular filtration rate,cameroon

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ScienceOpen disciplines: Medicine

Keywords: microalbuminuria, diabetes, diabetic nephropathy, glomerular filtration rate, cameroon

Prevalence and associations of microalbuminuria in proteinuria-negative patients with type 2 diabetes in two regional hospitals in Cameroon: a cross-sectional study

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Most cited references 19

Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes.

Kidney Disease and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus.

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