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Prediabetes is associated with microalbuminuria, reduced kidney function and chronic kidney disease in the general population

The KORA (Cooperative Health Research in the Augsburg Region) F4-Study
  • M.R.P. Markus
    Correspondence
    Corresponding author. University Medicine Greifswald, Department of Internal Medicine B, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. Fax: +49 (03834) 86 80502.
    Affiliations
    Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

    Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany

    German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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  • T. Ittermann
    Affiliations
    Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

    German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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  • S.E. Baumeister
    Affiliations
    Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

    Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany

    Chair of Epidemiology, Ludwig-Maximilians-University Munich, UNIKA-T Augsburg, Augsburg, Germany
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  • C. Huth
    Affiliations
    German Center for Diabetes Research (DZD), München-Neuherberg, Germany

    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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  • B. Thorand
    Affiliations
    German Center for Diabetes Research (DZD), München-Neuherberg, Germany

    Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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  • C. Herder
    Affiliations
    German Center for Diabetes Research (DZD), München-Neuherberg, Germany

    Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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  • M. Roden
    Affiliations
    German Center for Diabetes Research (DZD), München-Neuherberg, Germany

    Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany

    Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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  • U. Siewert-Markus
    Affiliations
    Institute for Psychology, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany

    Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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  • W. Rathmann
    Affiliations
    German Center for Diabetes Research (DZD), München-Neuherberg, Germany

    Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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  • W. Koenig
    Affiliations
    Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany

    German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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  • M. Dörr
    Affiliations
    Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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  • H. Völzke
    Affiliations
    Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

    German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany

    German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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  • S. Schipf
    Affiliations
    Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

    German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany
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  • C. Meisinger
    Affiliations
    Chair of Epidemiology, Ludwig-Maximilians-University Munich, UNIKA-T Augsburg, Augsburg, Germany

    German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Published:December 21, 2017DOI:https://doi.org/10.1016/j.numecd.2017.12.005

      Highlights

      • Glucose levels were positively associated with urinary albumin-to-creatinine ratio.
      • Prediabetes is associated with higher urinary albumin-to-creatinine ratio.
      • Prediabetes is associated lower estimated glomerular filtration rate.
      • Prediabetes increases the chances for chronic kidney disease.

      Abstract

      Background and Aims

      We investigated the associations of serum fasting (FG) and 2-h postload (2HG) glucose from an oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), fasting insulin and the homeostasis model assessment-insulin resistance index (HOMA-IR) with urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).

      Methods and Results

      We performed cross-sectional analyses of 2713 subjects (1429 women; 52.7%) without known type 2 diabetes, aged 31–82 years, from the KORA (Cooperative Health Research in the Augsburg Region) F4-Study. FG, 2HG, HbA1c, fasting insulin, HOMA-IR and glucose tolerance categories were analyzed for association with ACR and eGFR in multivariable adjusted linear and median regression models, and with isolated microalbuminuria (i-MA), isolated reduced kidney function (i-RKF) and chronic kidney disease (CKD, defined as MA and/or RKF) in multivariable adjusted logistic regression models. Among the 2713 study participants, 28% revealed prediabetes (isolated impaired fasting glucose [i-IFG], isolated glucose tolerance [i-IGT] or both by American Diabetes Association definition), 4.2% had unknown type 2 diabetes, 6.5% had i-MA, 3.1% i-RKF and 10.9% CKD. In multivariable adjusted analysis, all continuous variables (FG, 2HG, HbA1c, fasting insulin and HOMA-IR) were associated with i-MA, i-RKF and CKD. The odds ratios (ORs) for i-MA and CKD were 1.54 (95% confidence interval: 1.02–2.33) and 1.58 (1.10–2.25) for individuals with i-IFG. Moreover, the OR for i-RKF was 2.57 (1.31–5.06) for individuals with IFG + IGT.

      Conclusion

      Our findings suggest that prediabetes might have harmful effects on the kidney.

      Keywords

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