Association between Albumin Creatinine Ratio and e-GFR in Type 2 Diabetes Mellitus Patients in Oredo Local Government Area, Benin City, South-South Nigeria

Background: Diabetes mellitus is the commonest endocrine disease in Nigeria. Nephropathy is one of the complications of type 2 diabetes mellitus that could lead to end stage renal disease. Persistent microalbuminuria is a predictor of high risk of developing diabetic nephropathy. Early detection of kidney disease and intervention will prevent progression to end stage renal disease.
Objective: To determine the association between albumin creatinine ratio and eGFR in type 2 diabetic patients, their usefulness as early predictors of diabetic nephropathy and progression of disease.
Materials and Methods: This was a cross sectional study conducted in the State Specialist Hospital, Benin City, Edo State, Nigeria. Forty six type 2 diabetes mellitus patients, both male and female within the age range of 30 – 85 years were recruited for the study, after meeting the inclusion criteria. Twenty age and gender matched healthy subjects were selected as controls. Fasting plasma glucose, glycated haemoglobin, C-Reactive protein, serum creatinine were assayed. Urine albumin was estimated and albumin creatinine ratio determined, eGFR was estimated according to the Modification of Diet in Renal Disease (MDRD) formula.
Results: There was a significant difference between means of glycated haemoglobin, C – Reactive protein, Albumin creatinine ratio, eGFR of subjects which was (8.3±2.1%, 17.9±1.3 mg/l, 247.7±22.2 mg/g, 88±5.9 ml/min) respectively and that of controls which was (4.5±1.1%, 10.2±2 mg/l, 22.7±5.1 mg/g, 93.1±2.3 ml/min) p<0.05. ACR showed a strong and linear negative correlation with eGFR (r=-.682, p<0.05). A higher percentage of patients (64.7%) with e-GFR<60 ml/min had microalbuminuria, compared with (57.7%) with microalbuminuria in the subjects with eGFR>60 ml/min. Albuminuria worsened with increased duration of disease, as 55.6% of patients with diabetes mellitus of 5 years and above had macro albuminuria compared with 25% of patients with disease less than 5 years. Decline in eGFR increased with increasing duration of disease, 55.6% with disease duration of 5 years and above had eGFR<60 ml/min, compared with 45.5% in those with disease less than 5 years.
Conclusion: Albumin creatinine ratio and eGFR had a significant and linear negative correlation in this study. Therefore, they could be useful as predictors of early kidney disease in type 2 diabetes mellitus in this local government area. Increase in severity of albuminuria, coupled with higher prevalence of decline in eGFR with increasing duration of disease may be suggestive of their usefulness as predictors of disease progression.