Albuminuria predicts diabetic retinopathy and consequences of polyneuropathy in individuals with type 2 diabetes and chronic kidney disease: an observational nationwide Danish cohort study.

AIMS: Although albuminuria is an established prognostic marker in individuals with diabetes and chronic kidney disease (CKD), less is known about the association between albuminuria and retinal and neurological complications in large, unselected populations with type 2 diabetes and established CKD. We investigated the association of urine albumin-creatinine-ratio (UACR) on prevalence and incidence of microvascular complications in individuals with CKD.

METHODS

We included 27,924 adults with type 2 diabetes and CKD (eGFR < 60 ml min⁻1 1.73 m2⁻1) from Danish health care registers (2010-2023). Outcomes included diabetic retinopathy, polyneuropathy, and progression of CKD. Odds of retinopathy and polyneuropathy at baseline were evaluated using logistic regressions. Standardized 5-year risks of outcomes ere estimated using Cox regressions across UACR strata (<30, 30-100, 101-300, 301-1000, >1000 mg/g).

RESULTS

Median age was 75 years (IQR 69-80), 41.5% were female, and median eGFR was 53 ml min⁻1 1.73 m2⁻1 (IQR 47-56). Odds ratios for diabetic retinopathy and polyneuropathy were positively correlated with UACR. 5-year risks (95% CI) of all outcomes were similarly associated with increasing UACR levels.

CONCLUSION

Albuminuria was associated with a progressive increase in prevalence and incidence of microvascular disease in individuals with type 2 diabetes and CKD.