Rugera Simon Peter, Tumusiime Jazira, Mudondo Hope, Naruhura Georgina, Kiconco Ritah, Nkubi Bagenda Charles
Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, UGA.
Department of Biochemistry, Soroti University, Soroti, UGA.
Cureus. 2024 Sep 21;16(9):e69843. doi: 10.7759/cureus.69843. eCollection 2024 Sep.
Background Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by insulin resistance and high blood glucose levels, which has become a global pandemic in recent decades and is associated with several health complications, including renal dysfunction. Serum uric acid levels are associated with kidney damage and have been linked to various health conditions. Urine microalbumin is a sensitive marker of kidney damage and is commonly used to monitor renal dysfunction in diabetes. The study aimed to compare the predictive value of serum uric acid and urine microalbumin in detecting kidney damage among T2D patients. Method This secondary data analysis used a cross-sectional dataset of 140 diabetic patients from Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. The main outcome was renal dysfunction, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m². Key variables included serum uric acid, urinary microalbumin, and various demographic and clinical factors. Data were analyzed using logistic regression and receiver operating characteristic (ROC) curve analysis to evaluate predictive performance. Ethics approval was obtained from the Mbarara University Research Ethics Committee. Results This study involved 140 participants with a median age of 53 years (interquartile range (IQR) 44-60.5), predominantly females (95, 67.9%), primarily educated (76, 54.3%), and mostly married (104, 74.3%). Participants with renal dysfunction were older (median age 61 years, IQR 52-69) compared to those without (median age 49, IQR 40-56), with significant differences in urinary microalbumin and serum uric acid levels (p <0.05). Renal dysfunction prevalence was 33.6% (95% CI: 26.2-41.9), higher in participants with diabetes duration ≥5 years, microalbuminuria, certain marital statuses, and higher diastolic blood pressure. Microalbuminuria (adjusted odds ratio (aOR) 4.71, 95% CI: 1.27-17.50, P = 0.021) and serum uric acid (aOR 1.01, 95% CI: 1.0002-1.0153, P = 0.045) were significantly associated with renal dysfunction. Other associated factors included age, female gender, and diastolic hypertension. Both biomarkers had significant predictive power for renal dysfunction (area under the curve (AUC) 0.62 and 0.65, respectively). Conclusion This study confirms the high prevalence of renal dysfunction among T2D patients, with a finding of 33.6%. The significant association between microalbuminuria and renal dysfunction, as well as the predictive capacity of serum uric acid and urinary microalbumin, highlight the importance of these biomarkers in identifying individuals at risk of kidney complications.
背景 2 型糖尿病（T2D）是一种以胰岛素抵抗和高血糖水平为特征的慢性代谢紊乱疾病，近几十年来已成为全球性流行病，并与包括肾功能障碍在内的多种健康并发症相关。血清尿酸水平与肾脏损伤有关，并与各种健康状况相关联。尿微量白蛋白是肾脏损伤的敏感标志物，常用于监测糖尿病患者的肾功能障碍。本研究旨在比较血清尿酸和尿微量白蛋白在检测 T2D 患者肾脏损伤中的预测价值。
方法 本二次数据分析使用了乌干达姆巴拉拉市姆巴拉拉地区转诊医院（MRRH）140 例糖尿病患者的横断面数据集。主要结局是肾功能障碍，定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73m²。关键变量包括血清尿酸、尿微量白蛋白以及各种人口统计学和临床因素。使用逻辑回归和受试者工作特征（ROC）曲线分析来评估预测性能。获得了姆巴拉拉大学研究伦理委员会的伦理批准。
结果 本研究涉及 140 名参与者，中位年龄为 53 岁（四分位间距（IQR）44 - 60.5），以女性为主（95 名，67.9%），主要接受过教育（76 名，54.3%），大多已婚（104 名，74.3%）。与无肾功能障碍者（中位年龄 49 岁，IQR 40 - 56）相比，有肾功能障碍的参与者年龄更大（中位年龄 61 岁，IQR 52 - 69），尿微量白蛋白和血清尿酸水平存在显著差异（p <0.05）。肾功能障碍患病率为 33.6%（95%置信区间：26.2 - 41.9），在糖尿病病程≥5 年、微量白蛋白尿、某些婚姻状况以及舒张压较高的参与者中更高。微量白蛋白尿（调整后的优势比（aOR）4.71，95%置信区间：1.27 - 17.50，P = 0.021）和血清尿酸（aOR 1.01，95%置信区间：1.0002 - 1.0153，P = 0.045）与肾功能障碍显著相关。其他相关因素包括年龄、女性性别和舒张期高血压。两种生物标志物对肾功能障碍均具有显著的预测能力（曲线下面积（AUC）分别为 0.62 和 0.65）。
结论 本研究证实 T2D 患者中肾功能障碍的患病率很高，为 33.6%。微量白蛋白尿与肾功能障碍之间的显著关联以及血清尿酸和尿微量白蛋白的预测能力，突出了这些生物标志物在识别有肾脏并发症风险个体中的重要性。
