Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiovasc Diabetol. 2020 Jun 15;19(1):90. doi: 10.1186/s12933-020-01058-9.
Exercise induced albuminuria (EiA) is elevated in patients with metabolic dysfunction and diabetes, and may serve as an early biomarker for endothelial dysfunction and "kidney reserve". However, the change in EiA levels over time and its interaction with metabolic dysfunction and glucose metabolism has never been studied. Therefore, we sought to determine EiA levels over time in a cohort of individuals attending a routine annual health survey.
We prospectively enrolled 412 patients attending an annual healthy survey at our Medical Center. We collected urine samples for albumin and creatinine measurements before and immediately after completing an exercise stress test, along with multiple physiologic and metabolic parameters. Participants returned to a second follow up visit after a mean follow up period of 3 years (± 1.7 SD).
Patients with diagnosed diabetes and subjects with HbA1c ≥ 6.5% significantly increased their EiA over time (median [IQR] change between visits = 19.5 [- 10.4-56.1] vs. - 1.1 [- 12.7-4.9] (p = 0.049) for diabetics vs non-diabetics respectively). Moreover, a diabetes diagnosis was significantly associated with a high increase in EiA over time (top 10th percentile) even after adjusting for age, BMI, eGFR, METs, self-reported history of heart disease, systolic and diastolic blood pressure; OR = 4.4 (1.01-19.3 95% CI) (p = 0.049). Finally, elevated fasting blood glucose (≥ 100 mg/dl) was the strongest and only significant predictor for a greater increase in EiA over time after adjusting for all five metabolic syndrome components; blood glucose, waist circumference, blood triglycerides, HDL cholesterol, and BP criteria; OR = 4.0 (1.6-9.8 95% CI) (p < 0.01).
Patients with diabetes and/or elevated fasting blood glucose increase their exercise-induced urinary albumin excretion over time. The ability of EiA to predict major clinical outcomes in patients with and without diabetes needs to be determined in future studies.
运动诱导的白蛋白尿（EiA）在代谢功能障碍和糖尿病患者中升高，可能作为内皮功能障碍和“肾脏储备”的早期生物标志物。然而，EiA 水平随时间的变化及其与代谢功能障碍和葡萄糖代谢的相互作用从未被研究过。因此，我们试图确定在参加常规年度健康检查的患者队列中 EiA 随时间的变化。
我们前瞻性地招募了在我们的医疗中心参加年度健康检查的 412 名患者。我们在完成运动应激测试前后收集了尿液样本，用于测量白蛋白和肌酐，以及多项生理和代谢参数。在平均随访 3 年后（±1.7 SD），参与者返回第二次随访。
诊断为糖尿病的患者和 HbA1c≥6.5%的患者的 EiA 随时间显著增加（随访间中位数[IQR]变化分别为 19.5[-10.4-56.1]和-1.1[-12.7-4.9]（p=0.049））。此外，即使在调整年龄、BMI、eGFR、METs、自述心脏病史、收缩压和舒张压后，糖尿病诊断与 EiA 随时间的显著增加（前 10%）显著相关；OR=4.4（1.01-19.3 95%CI）（p=0.049）。最后，空腹血糖升高（≥100mg/dl）是调整所有五个代谢综合征成分后 EiA 随时间增加的最强和唯一显著预测因素；血糖、腰围、血液甘油三酯、HDL 胆固醇和血压标准；OR=4.0（1.6-9.8 95%CI）（p<0.01）。
患有糖尿病和/或空腹血糖升高的患者 EiA 随时间增加。需要在未来的研究中确定 EiA 在有和没有糖尿病的患者中预测主要临床结局的能力。
