Renal Biomarkers as Predictors of Renal Damage in Patients With Type 2 Diabetes

Diabetes mellitus (DM) is a chronic metabolic disease of global health concern. Type 2 diabetes mellitus (T2DM) is characterized by varying degrees of insulin resistance and impaired insulin secretion and can lead to renal dysfunction. This study, therefore, evaluated the prognostic potential of renal biomarkers as predictors of kidney damage in Sudanese T2DM.

An analytical case-control hospital-based study was conducted among patients attending the Kosti Diabetic Center (KDC) from March to October 2023. A total of 400 individuals were enrolled in the study: 200 with T2DM and 200 without T2DM as the control group. Their age and sex were matched. Serum urea, fasting blood glucose (FBG), creatinine, and albumin levels were estimated using a semiautomated biochemical analyzer; HbA1c levels were determined with a Getein 1100 analyzer. Data were analyzed using SPSS, and descriptive, t-tests, and multivariate analyses were performed.

Plasma urea (95% CI = 11.12 - 17.02, p < 0.001), creatinine (95% CI = 0.442 - 0.606, p < 001), urine albumin (95% CI = 111.78 - 138.63, p < 0.001), and albumin-to-creatinine ratio (ACR) (95% CI = 20.03 - 28.92, p < 0.001) were significantly higher in the case group than in the control group, while serum albumin (95% CI = -1.73 to -1.46, p < 0.001) and urine creatinine (95% CI = -103.79 to -78.02, p < 0.001) levels were significantly lower in the case group than in the control group. The results showed no significant differences in biochemical parameters by sex (p > 0.05). Serum urea and creatinine levels were significantly higher in patients with poor glycemic control (HbA1c ≥ 8) than in those with good glycemic control (HbA1c < 8) (p = 0.002 and p < 0.001, respectively). ACR weakly correlated with HbA1c and FBG levels (Spearman's correlation coefficient, r = 0.229, p < 0.001, and r = 0.201, p < 0.001, respectively) but strongly correlated with the duration of diabetes. There was a significant positive correlation between ACR and serum creatinine (r = 0.261, p < 0.001). At the same time, there was a significant negative correlation between ACR and serum albumin (r = -0.381, p < 0.001) and serum albumin and serum creatinine (r = -0.590, p < 0.001).

Patients with Type 2 diabetes have significantly higher serum urea, creatinine, and ACR levels. Renal dysfunction in Type 2 diabetics is associated with poor glycemic control and the duration of the disease.