The Importance of UACR (Urinary Albumin Creatinine Ratio) Examination in Patients with Diabetes Mellitus Type 2: A Systematic Review
DOI:
https://doi.org/10.26555/eshr.v6i2.8982Keywords:
DM 1, ESRD, ACR 3, diabetic nephropathy 4, UACR 5, Microalbuminuria 6Abstract
Background: Diabetes mellitus is a chronic metabolic condition causing elevated blood glucose levels, leading to microvascular and macrovascular consequences. It is a leading cause of end-stage kidney disease (ESKD) and end-stage renal disease (ESRD). Diabetes causes diabetic nephropathy, which is the leading cause of end-stage renal disease. The urinary albumin-to-creatinine ratio (UACR) is a clinically used tool to evaluate albuminuria and prevent the progression of diabetic nephropathy. ACR measurements are predictive markers for renal outcomes, cardiovascular outcomes, and mortality in diabetics. Microalbuminuria, a condition characterized by 30 to 300 mg/g in spot urine, is an independent predictor of coronary artery disease, cardiovascular disease, and all-cause mortality. This systematic review aimed to understand the role of ACR (albumin creatinine ratio) urine in patients with type 2 diabetes mellitus based on the published article.
Method: The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used databases ScienceDirect, PubMed, and Sage Journal to search for articles on urinary albumin creatinine ratio in type 2 diabetes mellitus. The search used keyword, inclusion and exclusion criteria to screen the article. 10 articles met our criteria and were included in this research.
Results: ACR (albumin creatinine ratio) levels are linked to cardiovascular risk in patients with diabetes mellitus (DM), and high UACR (urinary albumin creatinine ratio levels are linked to an increased risk of CKD (chronic kidney diseases). The patient's diabetes duration also impacts ACR levels. The KDI is a composite of eGFR (estimated glomerular filtration rate) and ACR risk variables with a clear linear relationship with all three outcomes. It may aid in the identification of high-risk individuals who will benefit the most from prophylactic medications.
Conclusion: Patients should be taught how better blood glucose and albuminuria control might help delay the progression of CKD. The male sex is protective; however, most female patients were postmenopausal with low estrogen levels, eliminating any potential renoprotective advantage. Dipsticks may be used for UACR testing, making it more convenient.
References
Rondhianto R, Siswoyo S, Fathoni A. Effectiveness of Empowerment-Based Diabetes Education on Diabetes Complication Prevention: A Systematic Review. Jurnal Aisyah: Jurnal Ilmu Kesehatan. 2022;7(4):1123–30.
International diabetes federation. IDF Diabetes Atlas 10th edition 2021. Available from: https://diabetesatlas.org/data/en/world/
Wada T, Mori-anai K, Kawaguchi Y, Katsumata H, Tsuda H, Iida M, et al. Renal, cardiovascular and safety outcomes of canagli fl ozin in patients with type 2 diabetes and nephropathy in East and South-East Asian countries: Results from the Canagli fl ozin and Renal Events in Diabetes with Established Nephropathy Clinical Eva. 2022;13(1).
Antwi-boasiako C, Amponsah K, Amissah-arthur KN, Musah L, Abaidoo B, Wedoi H, et al. Association between albuminuria and retinal microvascular dysfunction in type 2 diabetes with and without hypertension. Diabetes Epidemiology and Management. 2023;11:100139.
Afera SL, Santoso SD, Santosa RI. Rasio Albumin Kreatinin Urin Sebagai Deteksi Dini Gangguan Fungsi Ginjal Pada Diabetes Melitus. Jurnal SainHealth. 2021;5(2):1–5.
Wang Z, Yuan J, Wan W bin, Ding J, Han L, Zhao P, et al. Positive association between urinary albumin-creatinine ratio and lower extremity peripheral arterial disease in Chinese diabetes patients: A cross-section study with propensity score matching analysis. Nutrition, Metabolism and Cardiovascular Diseases. 2023;33(3):541–50.
Hou L, Shi Y, Wang S, Chen Q, Li Q, Zhao M, et al. Associations of serum uric acid level with diabetic retinopathy and albuminuria in patients with type 2 diabetes mellitus. Journal of International Medical Research. 2020; 48(12):300060520963980.
Gerstein HC, Ramasundarahettige C, Avezum A, Basile J, Conget I, Cushman WC, et al. A novel kidney disease index reflecting both the albumin to creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes. Cardiovascular Diabetology. 2022;1–8.
Ren F, Li M, Hua MM, Bd X, Qin X, Mm YT. Urine albumin- to- creatinine ratio within the normal range and risk of hypertension in the general population: A meta- analysis. J Clin Hypertens (Greenwich). 2021;(March):1284–90.
Bpharm WT, Kerr SJ, Boonyakrai C, Udomkarnjananun S, Mrn SC, Sakulbumrungsil R. Development and Validation of a Chronic Kidney Disease Prediction Model for Type 2 Diabetes Mellitus in Thailand. Value in Health Regional Issues. 2020;24:157–66.
Stack AG, Dronamraju N, Parkinson J, Johansson S, Johnsson E, Erlandsson F, et al. Effect of Intensive Urate Lowering with Combined Verinurad and Febuxostat on Albuminuria in Patients With Type 2 Diabetes: A Randomized Trial. American Journal of Kidney Diseases. 2021;77(4):481–9.
Xie Y, Jin D, Qiu H, Lin L, Sun S, Li D, et al. Assessment of urinary podocalyxin as an alternative marker for urinary albumin creatinine ratio in early stage of diabetic kidney disease in older patients. NEFROLOGIA (English Edition). 2022;42(6):664–70.
Nowak N, Skupien J, Smiles AM, Yamanouchi M, Niewczas MA, Galecki AT, et al. Markers of early progressive renal decline in type 2 diabetes suggest different implications for etiological studies and prognostic tests development. 2018;1198–206.
Shibata M, Nakano T, Tsuboi N, Oda Y, Kitazono T. Pathologic Diabetic Nephropathy in Autopsied Diabetic Cases with Normoalbuminuria from a Japanese Community-Based Study. Kidney International Reports. 2021;6(12):3035–44.
Kin W, Tsai S sheng, Li Y rong, Chou W yu. Association between serum bilirubin levels and progression of albuminuria in Taiwanese with type 2 diabetes mellitus. Biomedical Journal. 2021;44(2):201–8.
Kobayashi K, Toyoda M, Kimura M, Hatori N, Furuki T, Sakai H, et al. Retrospective analysis of effects of inhibitor in Japanese type 2 diabetes mellitus patients with chronic kidney disease. Diabetes and Vascular Disease Research. 2019; 16(1):147916411880275
Xia L, Cheng L, Jiang T, et al. Estimation of the prevalence of type 2 diabetes in combination with diabetic kidney disease and identification of the associated factors in patients attending primary hospitals in Anhui Province, China. Journal of International Medical Research. 2021;(81).
Xie Y, Jin D, Qiu H, Lin L, Sun S, Li D, et al. Assessment of urinary podocalyxin as an alternative marker for urinary albumin creatinine ratio in early stage of diabetic kidney disease in older patients. Nefrología (English Edition).2022; Nov-Dec;42(6):664-670.
Sauriasari R, Dafitri DD, and Azmi NU. Current updates on protein as biomarkers for diabetic kidney disease: a systematic review. Therapeutic Advances in Endocrinology and Metabolism 2021;1–13.
Thipsawat S. Early detection of diabetic nephropathy in patient with type 2 diabetes mellitus: A review of the literature. Diabetes & Vascular Disease Research. 2021;(December):1–9.
Lee CL, Chen CH, Wu MJ, Tsai SF. The variability of glycated hemoglobin is associated with renal function decline in patients with type 2 diabetes. Therapeutic Advances in Chronic Disease. 2020 Jan 1;11:2040622319898370.
Suherman, Sopiah P, Ridwan H. Literature Review: Hubungan Diabetes Melitus Dengan Kejadian Gagal Ginjal Kronik. Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing). 2023;9(5):639–44.
Hashmi MF, Benjamin O, Lappin SL. End-Stage Renal Disease. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499861/
Liu J, Liu Z, Sun W, Luo L, An X, Yu D, et al. Role of sex hormones in diabetic nephropathy. Frontiers in Endocrinology. 2023;14(April):1–11.
Tahfim T, Sultana GS, Era MstHS, Yesmin F, Ruma RA, Sultana L. Association between serum bilirubin and estimated glomerular filtration rate in diabetic patients with chronic kidney disease. IMC Journal of Medical Science. 2023;18(1):1–6.
Siraj J, Abateka T, Kebede O. Patients’ Adherence to Anti-diabetic Medications and Associated Factors in Mizan-Tepi University Teaching Hospital: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2021 Jan 1;58:469580211067477.
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