#27 Progression and Regression of Albuminuria in Youth with Type 2 Diabetes
Farrah Jabar, University of Manitoba; Brandy Wicklow, University of Manitoba; Jonathan McGavock, University of Manitoba; Elizabeth Sellers, University of Manitoba; Tom Blydt-Hansen, University of British Columbia; Kristine Kroeker, George and Fay Yee Centre for Health Innovation; Dan Chateau, University of Manitoba; Allison Dart, University of Manitoba
The rate of youth-onset type 2 diabetes (T2D) in Manitoba is 12-20x higher than any other region in Canada. Youth with T2D are at a high risk for progression to end-stage renal disease at a younger age, however the natural history of albuminuria over time is unknown. Our objectives are to evaluate changes in albuminuria status over time and determine associated risk factors for this progression. We hypothesize that duration of diabetes, glycemic control (HbA1c), hypertension, and inflammation are predictors of albuminuria.
Baseline clinical factors and plasma and urine cytokines were compared among 124 youth with T2D from The Improving renal Complications in Adolescents with T2D through REsearch study. Youth were stratified based on changes in albuminuria from baseline appointment to last follow-up: normal [albumin:creatinine ratio (ACR) <2mg/mmol throughout]; progression [ACR normal to >2mg/mmol OR 2-<20 to >20mg/mmol]; regression (ACR > 2 to <2 OR >20 to 2-<20mg/mmol); and persistent (ACR category remained the same throughout).
Median ACR was 0.72 mg/mmol at baseline, 1.2 at 1 year (n=31), 1.7 at 2 years (n=70), 2.3 at 3 years (n=20). At last follow-up, 48.4% remained normal, 26.6% progressed, 8.1% reverted, and 16.9% had persistent albuminuria. Compared to normal, progression and persistent albuminuria were associated with longer duration of diabetes (1.7 vs. 1.8 vs. 3.4 years, respectively; p=0.02), higher HbA1c (8.8 vs. 9.2 vs. 10.8%; p=0.0006), and higher systolic (20.6 vs. 28 vs. 57%; p=0.003) and diastolic (9.3 vs. 15.8 vs. 19.6% p=0.006) blood pressure loads (% of time >95th %ile). Cytokines did not predict albuminuria status (n=50). Reverters were more likely to be on an ACE inhibitor (p<0.00001).
Youth with T2D have high rates of albuminuria. Traditional risk factors including longer duration of diabetes, poor glycemic control, and hypertension predict worsening albuminuria. Larger sample sizes are needed to evaluate cytokine profiles.