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

• DOI: 10.1016/j.numecd.2017.12.005
• Publication Date: 2017-12-22T01:43:52Z
• Authors: M.R.P. Markus; T. Ittermann; S.E. Baumeister; C. Huth; B. Thorand; C. Herder; M. Roden; U. Siewert-Markus; W. Rathmann; W. Koenig; M. Dörr; H. Völzke; S. Schipf; C. Meisinger
• Keywords: Adult; Blood Glucose; Male; Kidney; Prediabetic State; 03 medical and health sciences; 0302 clinical medicine; Germany; Albuminuria; Humans; Insulin; Aged; Aged, 80 and over; Glycated Hemoglobin; Fasting; Glucose Tolerance Test; Middle Aged; 3. Good health; Cross-Sectional Studies; Albuminuria ; Chronic Kidney Disease ; Diabetes ; Insulin Resistance ; Microalbuminuria; Creatinine; Female; Biomarkers; Glomerular Filtration Rate

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