Correlation between Proteinuria and Glomerular Filtration Rate in Type 2 Diabetes Mellitus

Dani Rosdiana, Mukhyarjon Mukhyarjon, Hendra Asputra, Nisa Faradisa Hernita, Olivia Makmur, Prayogo Prayogo, Hetty Hirfawaty

Abstract


Indonesia faces a double burden of communicable and non-communicable diseases, including metabolic and degenerative problems. Delay in the detection of diabetic nephropathy (DN) as one of the chronic microvascular complications is often seen, leading to the need for hemodialysis due to the end-stage renal disease (ESRD). An assessment of diabetes mellitus (DM) control target achievement, based on the guideline from the Indonesian Society of Endocrinology (Perkumpulan Endokrinologi Indonesia, PERKENI), and nephropathy early detection was performed in 54 Type-2 DM patients from 5 private hospitals in Pekanbaru Riau, Indonesia, from November 2018 to September 2019. Results showed poor achievement of DM control with 61.1% had abnormal body mass index, 57.5% had HbA1c>7%, and 77.7% had LDL serum >100 mg/dL. Nevertheless, most patients achieved good blood pressure control (74%). A high percentage of nephropathy-proteinuria was seen (40.7%) with 40.9% of them revealed renal insufficiency classified as chronic kidney disease (CKD) stage 3 and 4. There was a significant correlation between proteinuria and declined GFR (p=0.016), onset of DM (p=0.02), and diastolic blood pressure (p=0.03). No correlation was found between HbA1c and declined GFR, which may be due to the cross-sectional nature of the study. It will be interesting to perform a prospective study on proteinuria modification as a predictor of nephropathy early detection in DM patients since kidney biopsy and urine albumin creatinine ratio assessment are not available in primary health care services in remote areas.

 

Korelasi antara Proteinuria dan Laju Filtrasi Glomerulus pada Diabetes Melitus Tipe 2

Indonesia menghadapi beban ganda penyakit menular dan tidak menular, termasuk masalah metabolisme dan degeneratif. Keterlambatan dalam deteksi nefropati diabetik sebagai salah satu komplikasi mikrovaskular kronis sering terlihat, mengarah pada kebutuhan untuk hemodialisis karena penyakit ginjal stadium akhir (ESRD). Dari 54 pasien diabetes melitus (DM) tipe-2 tanpa keluhan edema, sesak, dan lemas dari 5 rumah sakit swasta di Pekanbaru, Riau, Indonesia, dari November 2018 hingga September 2019, dilakukan penilaian kontrol DM sesuai panduan Perkumpulan Endokrinologi Indonesia (PERKENI). Didapatkan hasil bahwa pencapaian kontrol DM masih buruk dengan 61,1% memiliki indeks massa tubuh abnormal 57,5% memiliki HbA1c >7%, dan 77,7% memiliki serum LDL >100 mg/dL. Namun demikian, sebagian besar pasien mencapai kontrol tekanan darah yang baik (74%). Pasien terdeteksi proteinuria >25 mg/dL mencapai 40,7% dengan 40,9% diantaranya mengalami gangguan filtrasi ginjal yang didefinisikan sebagai GFR <60 diklasifikasikan penyakit ginjal kronis tahap 3 dan 4. Walaupun secara statistik tidak ditemukan hubungan bermakna antara kontrol glikemik dengan insufisiensi renal, namun ditemukan hubungan yang bermakna antara nefropati dengan penurunan laju filtrasi glomerulus (GFR) (p=0.016), awitan DM (p=0,02), dan tekanan darah diastolik (p=0,03). Tidak ada hubungan bermakna antara HbA1c dan penurunan GFR yang mungkin disebabkan observasi sesaat. Akan menarik untuk melakukan studi prospektif pada modifikasi proteinuria sebagai prediktor deteksi dini nefropati pada pasien DM karena biopsi ginjal dan penilaian rasio albumin kreatinin urin tidak tersedia di layanan perawatan kesehatan primer di daerah terpencil.


Keywords


Diabetic control; diabetic nephropathy; glomerular filtration rate; proteinuria; type-2 DM

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DOI: https://doi.org/10.15395/mkb.v52n2.1811

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