Abstract
Aim
We aim to study association serum creatinine(cr) variability and albuminuria progression.
Methods
We conducted a retrospective cohort study on patients with Type 2 Diabetes Mellitus
at a Diabetes Centre in Singapore (“discovery cohort”). Outcome is worsening of urinary
albumin-to-creatinine(ACR) across stages. Cr variability was expressed as adjusted
cr-intrapersonal standard deviation(SD) and coefficient-of-variation(cr-CV). A separate
cohort was used for validating association between cr variability and albuminuria
progression (“validation cohort”).
Results
Over median follow-up of 4.2 years, 38.4% of 636 patients had albuminuria progression
in the discovery cohort. Increasing log-transformed adjusted cr-intrapersonal SD and
cr-CV were significantly associated with albuminuria progression: HRs 1.43 (95%CI
1.11–1.85) and 1.44 (1.11–1.87) respectively in the discovery cohort, and HRs 1.94
(1.09–3.45) and 1.91 (1.05–3.45) respectively in the validation cohort. When stratified
by baseline urinary ACR, higher cr variability was significantly associated with albuminuria
progression in patients with normoalbuminuria but not microalbuminuria.
Conclusions
Cr variability independently predicts albuminuria onset. This is evident in patients
with normoalbuminuria, suggesting that higher cr variability could herald albuminuria
onset.
Keywords
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Article info
Publication history
Published online: January 17, 2018
Accepted:
November 7,
2017
Received in revised form:
October 10,
2017
Received:
August 26,
2017
Identification
Copyright
© 2017 Published by Elsevier Ireland Ltd.
