Low-grade albuminuria is associated with peripheral artery disease in Chinese diabetic patients

Increasing studies have suggested that albuminuria might be an important risk factor for peripheral artery disease (PAD). However, studies focusing on the association between low-grade albuminuria and PAD are limited. It would be of great interest to elucidate the association between low-grade albuminuria and PAD in diabetic subjects.

A cross-sectional study was conducted in 1386 diabetic subjects (age ≥ 40 years) with normal urinary albumin levels from Shanghai, China. A first voided early morning spot urine sample was obtained for urinary albumin and creatinine measurements. Subjects were divided into three groups according to sex-specific cutoff points of urinary albumin-creatinine ratio (UACR) tertiles. Subjects in the upper tertile of UACR were classified as having low-grade albuminuria. PAD was defined by ankle-brachial index (ABI) <0.9 or >1.4.

Overall, 106 (7.7%) of the study population had PAD. The prevalence of PAD in tertile 3 of UACR was higher than the prevalence in tertile 2 and tertile 1 (10.2%, 6.4% and 6.4%, respectively; P < 0.05). A fully adjusted logistic regression analysis revealed that compared with subjects in tertile 1 of normal UACR, those in tertile 3 had 1.7-fold increased risk for the presence of PAD.

In diabetic patients, high normal UACR level, which is below the current cutoff point of microalbuminuria, was associated with the increased prevalence of PAD. It suggested that low-grade albuminuria might be an early marker for the detection of PAD in diabetic patients.