Progression of microalbuminuria among diabetic patients attending Muhimbili National Hospital Dar es salaam, Tanzania over a nine year period.

Abstract

Background Microalbuminuria presents with different degrees of progression as it may regress to normoalbuminuria or progress to the irreversible stage of diabetic nephropathy and eventually end stage renal disease. Most available information are reports of studies done among Caucasians and there is paucity of such evidence among diabetic African patients describing the progression of microalbuminuria. This study aimed at determining the progression of microalbuminuria in patients with diabetes over a nine year period at MNH.

Methods A retrospective cohort study involved 259 participants a cohort of type 1 and type 2 diabetic patients who participated in the baseline study in 2003/2004. Urine samples were first screened using dipstick strip from the spot morning void urine. Patients who had dipstick negative for albuminuria were further tested using a semi-quantitative assay to determine albuminuria and creatinine concentrations in order to calculate ACR. Further information obtained included age, diabetes duration, sex, body mass index, blood pressure, serum lipid profile, serum creatinine and glycated haemoglobin.

Results High proportion of patients with microalbuminuria progression occurred in type 2 diabetes (83.3%) whereas half of the patients with diabetes type 1 presented with microalbuminuria persistence. Risk factor assessment showed that diabetic duration of 10-15yrs, poor glycemic control especially HbA1C >10%, isolated diastolic and both systolic and diastolic hypertension were associated with microalbuminuria progression.

Conclusion This study aimed at assessing the progression of microalbuminuria among diabetic patients over nine years at MNH diabetic clinic. The main finding of the study was high rate of microalbuminuria progression which occurred among the diabetic patients. Among the 74 patients with normoalbuminuria at the baseline who could be traced 93.2% of them their albuminuria progressed either to microalbuminuria 37 (50%), or progressed to macroalbuminuria 32 (43.2%). Whereas among those patients who had microalbuminuria at baseline, 75% progressed to macroalbuminuria and 25% persisted as microalbuminuria, none of them regressed towards normoalbuminuria. Additionally we found that progression of albuminuria occurred in both diabetic groups, the majority of progressers (83%) were observed among type 2 diabetic patients. This progression occurred mainly among diabetic patients with diabetic duration 10-15yrs, poor glycemic control (HbA1C >10%) and diastolic or both systolic and diastolic hypertension.