Low-grade albuminuria is associated with poor memory performance in the nondemented Chinese elderly with type 2 diabetes

Chronic kidney disease and cognitive decline in patients with type 2 diabetes at elevated cardiovascular risk

AIMS

We addressed the question whether chronic kidney disease (CKD) may contribute to cognitive decline in type 2 diabetes.

METHODS

Participants with type 2 diabetes with elevated cardiovascular risk or CKD from cognition substudies of two large trials were studied prospectively (CARMELINA: n = 2666, mean ± SD age 68.1 ± 8.7 years, CAROLINA: n = 4296; 64.7 ± 9.4 years). Estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) at baseline were related to cognitive performance (Mini-Mental State Examination (MMSE) and attention and executive functioning score (A&E)) in linear regression analyses, adjusted for demographics, cardiovascular risk factors and treatment, at baseline and follow-up.

RESULTS

CKD at baseline was more common in CARMELINA than CAROLINA (eGFR<60 in 72.6 % and 19.6 %, macroalbuminuria in 35.0 % and 4.1 %, respectively). Baseline eGFR was related to A&E in CARMELINA (b = 0.02 per 10 ml/min/1.73m², 95%CI [0.01,0.03]). Baseline UACR was related to A&E in CAROLINA (b = -0.01 per doubling of UACR mg/g, 95%CI [-0.02,-0.002]). Baseline UACR predicted decline in A&E in CAROLINA (median 6.1 years follow-up; b = -0.01, 95%CI [-0.03,-0.0001] per doubling of UACR mg/g).

CONCLUSIONS

eGFR and UACR were associated with A&E in two cohorts with type 2 diabetes, enriched for CKD and cardiovascular disease. The small effect size estimates indicate limited impact of kidney dysfunction on cognition in this setting.

GOV IDENTIFIERS

NCT01897532 NCT01243424.

Low-grade albuminuria in adult and elderly individuals with diabetes mellitus and arterial hypertension accompanied by Primary Health Care

Diabetes mellitus (DM) and arterial hypertension (AH) are the two main clinical conditions related to Chronic Kidney Disease (CKD); disease also identify by the levels of low-grade albuminuria (LGA). Few studies have simultaneously investigated the associations of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) with LGA. Our study aimed to investigate and compare the association of HbA1c and FPG with the probability of LGA in adult and elderly individuals with DM and AH, within the scope of Primary Health Care (PHC). Cross-sectional study involving 737 Brazilians individuals previously diagnosed with hypertension and/or diabetes. Tests for HbA1c, FPG and LGA were performed. LGA was defined as the highest quartile of albumin urinary (≥ 13 mg/g) among individuals with urinary LGA < 30 mg / g. A significant increase in the prevalence of LGA was found with increasing levels of HbA1c (p < 0.001). There was a significant association of HbA1c with LGA (p < 0.001) and increased probability of LGA for participants with HbA1c ≥ 6.5% compared to those with Hba1c < 5.7% (OR [95% CI]: 2.43 [1.32-4.46], p < 0.05), after adjusting for confounding factors, except when adjusted for FPG (p = 0.379 and p = 0.359, respectively). HbA1c and FPG were significantly associated in a collinear manner with an increased probability of LGA in adult and elderly individuals with DM and AH.

Low-grade albuminuria is associated with hearing loss in non-diabetic US males: A cross-sectional analysis of 1999-2004 national health and nutrition examination survey

High levels of albuminuria have been demonstrated to associate with hearing loss in non-diabetic people, while the clinical impact of low-grade albuminuria has attracted less attention. This cross-sectional population-based study aimed to examine whether hearing loss in non-diabetic United States (US) adults is independently associated with low-grade albuminuria or reduced estimated glomeruli filtration rate (eGFR).A total of 2518 participants aged 20 to 69 years were selected from the US National Health and Nutritional Examination Survey database. Participants with diabetes or high-grade albuminuria were excluded. Hearing loss was assessed using low-frequency pure-tone average (LFPTA) thresholds (0.5, 1.0, 2.0 kHz) and high-frequency pure-tone average (HFPTA) thresholds (3.0, 4.0, 6.0, 8.0 kHz). Logistic and linear regression analyses were used to evaluate associations between renal function indicators and hearing loss.The median age of included participants was 37.4 years, and 55% of them were female. Multivariate analysis revealed that participants with urinary albumin-to-creatinine ratio (UACR) in the highest tertile had a significantly higher risk of hearing loss (OR, 1.79; 95% CI, 1.01-3.19) and higher HFPTA thresholds (β: 2.23; SE: 0.77). Participants with eGFR <60 mL/min/1.73 m had higher LFPTA thresholds (β: 4.31; SE: 1.79). After stratification by sex, a significant risk remained only for males in the highest UACR tertile, with 2.18 times the risk of hearing loss (95% CI, 1.06-4.48).Non-diabetic US males with low-grade albuminuria are at increased risk of hearing loss, independent of eGFR.