Abstract:
Introduction. Onset of nephropathy in patients with type 2 diabetes (T2DM) increases the cardiovascular disease (CVD) risk.
Association of the parameters of diabetic nephropathy such as albuminuria and estimated Glomerular fltration rate (eGFR) with
predicted CVD risk has not been studied in Sri Lankan patients with T2DM. Methods. In a cross-sectional study of patients who
underwent single visit screening at a diabetes center in Sri Lanka, we obtained demographic and biochemical data.Tose with urine
albumin excretion over 30 mg/g creatinine were considered as having albuminuria, and eGFR was calculated using modifed diet in
renal disease (MDRD) formula. Ten-year coronary heart disease risk (CHDR) in all patients was calculated using United Kingdom
Prospective Diabetes Study risk engine, and those with CHDR > 10% were considered as having high risk. Spearman correlation was
used to study the association between eGFR and CHDR, and logistic regression analysis was carried out to study the association of
albuminuria and eGFR with high (>10%) CHDR. Results. Of the patients with diabetes studied (n=2434), 64% (1563) were males.
Mean (SD) age and duration of diabetes were 52 (11) and 9 (3) years, respectively. Normoalbuminuria, microalbuminuria, and
macroalbuminuria were observed in 16.4%, 14.8%, and 68.7% of patients, respectively. Tree hundred ninety-four (16.2%) patients
had eGFR < 60 ml/min. Moderate correlation was observed between eGFR and predicted CHDR [r = (-0.4), P<0.01] and between
eGFR and fatal CHDR (FCHDR) [r = (-0.5), P<0.01]. Independent t-test showed that patients with eGFR < 60 ml/min were older
and had longer diabetes duration and lesser BMI compared to those who had eGFR > 60 ml/min (P < 0.01). On logistic regression,
nephropathy according to eGFR became a strong predictor for high CHDR (OR; 3.497, 95% CI 2.08 to 5.87), and nephropathy
according to albuminuria and both albuminuria and eGFR was not signifcant predictor of CHDR. Conclusions. Predicted CHDR
shows a moderate and signifcant association with eGFR in patients with T2DM without symptomatic CVD. eGFR is a stronger
predictor than albuminuria in predicting high CHDR in patients with T2DM. Intensifcation of CVD prevention measures should
be done more confdently among patients with T2DM and reduced eGFR than in those with albuminuria alone.
