PeerJ · 2025
The association between the extracellular water-to-total body water ratio and albuminuria in Chinese type 2 diabetes mellitus patients.
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Yang Aili, Yu Xinwen, Fan Zhiqiao, Jin Yuxin, Sun Fei, Wang Xin, Yuan Xi, Liu Langlang, Zhao Guohong, Gao Bin
Аннотация
BACKGROUND: Diabetic kidney disease (DKD) is a common complication in patients with type 2 diabetes (T2DM), and early screening and diagnosis are crucial for preventing end-stage renal disease (ESRD). The extracellular water/total body water (ECW/TBW), as measured by bioelectrical impedance analysis (BIA), may be closely associated with the development of DKD. This study aimed to evaluate the relationship between ECW/TBW and albuminuria in T2DM patients and to explore its potential as an early diagnostic tool.
MATERIALS AND METHODS: This study included 1,034 T2DM patients. Demographic information, medical history, medication use, and laboratory test results were collected, including glycated hemoglobin (HbA1c), creatinine, lipid profile, and the urine albumin-creatinine ratio (UACR). BIA was used to measure parameters such as ECW/TBW. Multivariate logistic regression analysis explored the correlation between ECW/TBW and UACR. Ultimately, two simple nomograms were established to predict macroalbuminuria from patients with normoalbuminuria and microalbuminuria, respectively.
RESULTS: The ECW/TBW increased significantly with rising UACR levels. Multivariate logistic regression analysis showed that ECW/TBW was significantly associated with macroalbuminuria compared to both normo-albuminuria and microalbuminuria (OR = 2.082, 95% CI [1.476-2.937], P < 0.001; and OR = 1.642, 95% CI [1.129-2.386], P = 0.009, respectively). In the analysis stratified by renal function, a similar relationship was found only in patients with eGFR ≥ 60 mL/min/1.73 m2 (OR = 2.108, 95% CI [1.479-3.004], P < 0.001) but not in patients with eGFR < 60 mL/min/1.73 m2. Finally, two nomograms for predicting macroalbuminuria were established. The C-index of the nomogram model for predicting the macroalbuminuria in patients with normoalbuminuria was 0.795 (95% CI [0.752-0.838]), and the C-index of the nomogram model for predicting the macroalbuminuria in patients with microalbuminuria was 0.761 (95% CI [0.711-0.812]).
CONCLUSIONS: This study demonstrated a significant correlation between the ECW/TBW and UACR levels in Chinese T2DM patients. In patients with normal or mildly impaired renal function (eGFR ≥ 60 mL/min/1.73 m2), ECW/TBW was significantly associated with macroalbuminuria, potentially serving as a diagnostic marker for macroalbuminuria.
MATERIALS AND METHODS: This study included 1,034 T2DM patients. Demographic information, medical history, medication use, and laboratory test results were collected, including glycated hemoglobin (HbA1c), creatinine, lipid profile, and the urine albumin-creatinine ratio (UACR). BIA was used to measure parameters such as ECW/TBW. Multivariate logistic regression analysis explored the correlation between ECW/TBW and UACR. Ultimately, two simple nomograms were established to predict macroalbuminuria from patients with normoalbuminuria and microalbuminuria, respectively.
RESULTS: The ECW/TBW increased significantly with rising UACR levels. Multivariate logistic regression analysis showed that ECW/TBW was significantly associated with macroalbuminuria compared to both normo-albuminuria and microalbuminuria (OR = 2.082, 95% CI [1.476-2.937], P < 0.001; and OR = 1.642, 95% CI [1.129-2.386], P = 0.009, respectively). In the analysis stratified by renal function, a similar relationship was found only in patients with eGFR ≥ 60 mL/min/1.73 m2 (OR = 2.108, 95% CI [1.479-3.004], P < 0.001) but not in patients with eGFR < 60 mL/min/1.73 m2. Finally, two nomograms for predicting macroalbuminuria were established. The C-index of the nomogram model for predicting the macroalbuminuria in patients with normoalbuminuria was 0.795 (95% CI [0.752-0.838]), and the C-index of the nomogram model for predicting the macroalbuminuria in patients with microalbuminuria was 0.761 (95% CI [0.711-0.812]).
CONCLUSIONS: This study demonstrated a significant correlation between the ECW/TBW and UACR levels in Chinese T2DM patients. In patients with normal or mildly impaired renal function (eGFR ≥ 60 mL/min/1.73 m2), ECW/TBW was significantly associated with macroalbuminuria, potentially serving as a diagnostic marker for macroalbuminuria.