PREVALENCE OF MICROALBUMINURIA AMONG DIABETIC PATIENTS IN ABUTH, SHIKA ZARIA

PREVALENCE OF MICROALBUMINURIA AMONG DIABETIC PATIENTS IN ABUTH, SHIKA ZARIA

Abstract:

Diabetic nephropathy accounts for a significant reduction in life expectancy of diabetic patients. Diabetic patients with microalbuminuria have increased risk of progression to overt proteinuria and later progress to renal failure which is usually irreversible and eventually leads to death. The prevalence and risk factors of microalbuminuria are not fully described among black African diabetic patients. The objective of the present study was to determine the prevalence of micro-albuminuria and associated factors among diabetic patients in ABUTH, Shika, Zaria. This was a cross-sectional study of diabetic patients attending ABUTH, Zaria. Concentrations of Fasting blood glucose (FBG), serum creatinine (SCr), Urinary creatinine (UCr), and glycated haemoglobin (GHbA1c) were measured in 170 diabetic patients and 100 apparently healthy individuals. Microalbuminuria was measured using immunoturbidimetric method and was defined as Albumin-creatinine ratio ACR between 3–30 mg/mmol. Duration of diagnosis (DOD), Body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were also measured, where applicable, in both patients and controls. The prevalence of microalbuminuria among the diabetic patients in this study was 23%. Mean values in patients versus controls of BMI (26.8±0.43 vs 23.4±0.43kg/m2, p<0.001), DBP (80±0.56 vs 72±0.69mmHg, p<0.001), FBG (6.3±0.22 vs 3.5±0.07mmol/L, p<0.001), UAlb (20.2±2.17 vs 8.0±0.31mg/L, p<0.001), GHbA1c (7.2±0.16 vs 4.9±0.07%, p<0.001) and ACR (2.7±0.29 vs 1.0±0.04 mg/mmol, p<0.001) were observed to be higher with statistically significant differences in patients than controls (p<0.05). Similar higher and statistically significant values were also observed in mean values of FBG, GHbA1c, UCr, UAlb and ACR in microalbuminuric patients than normoalbuminuric patients (p<0.05). Sixty one (35.9%) had good glycaemic control with 11.5% having abnormal ACR, 42 (24.7%) at borderline had 14.3% with abnormal ACR and 67(39.4%) those with poorly controlled glycaemia had 28.4% with abnormal ACR. One hundred and eighteen (69.4%) were within 0-5years of duration having 25(21%) with abnormal ACR, those within 6- 10yr of duration were 37(21.8%) had 10(27%) with abnormal ACR while those with duration of ≥11years were 15(8.8%) had 6(40%) indicating linear relation with both GHbA1c and DOD. There was a positive and significant correlation between serum creatinine and age in both patients (p=0.031, r=0.216) and controls (p=0.014, r=0.244). Positive correlation was also observed between duration of diagnosis and serum creatinine among patients (p=0.047, r=0.152). ACR was found to correlate positively with GHbA1c in patients (p=0.013, r=0.189) and with BMI among controls (p=0.031, r=0.216). A reference range of 0.14-1.78 mg/mmol and clinical decision limit of 2.19 mg/mmol for microalbuminuria and of 3.43-6.39 % and a clinical decision limit of 7.13 % for glycated haemoglobin were established. The only modifiable predictor identified in this study was poor glycaemic control for the development of microalbuminuria. Other non modifiable risk factors related to progression of microalbuminuria were age and duration of diagnosis. Aggressive glycaemic control is hereby recommended for better management and preventive measures to halt or slow the progression rate of renal involvement in diabetic patients.

PREVALENCE OF MICROALBUMINURIA AMONG DIABETIC PATIENTS IN ABUTH, SHIKA ZARIA