The Association between Urinary Albumin Excretion and Ankle-Brachial Index in Elderly Taiwanese Patients with Type 2 Diabetes Mellitus

Objective: this study examined the association between urinary albumin/ creatinine ratio (ACR) and ankle-brachial index (ABI), or peripheral arterial disease (PAD), in elderly patients with type 2 diabetes mellitus (T2DM). Methods: a total of 290 (108 men, 182 women) T2DM, aged 65 ( 71.6 4.9) years were recruited. PAD was diagnosed by ABI0.9 , and ACR was divided into normoalbuminuria (30.0 g/mg), microalbuminuria (30.0 299.9 g/ mg), and macroalbuminuria ( 300.0 g/mg). Results patients with PAD (n = 45 ) had higher ln(ACR) than patients without: 4.48 +/- 1.48 versus 3.73 +/- 1.39 (P< 0.01). For normoalbuminuria (n = 112), microalbuminuria (n = 152) , and macroalbuminuria (n = 26), respective PAD prevalence was 8.0, 17.1 and 38.5% (P< 0.001) . The proportion of normoalbuminuria, microalbuminuria and macroalbuminuria in patients with PAD was 20.0, 57.8 and 22. 2%, respectively; and 42.0, 51.4 and 6.5%, respectively, in patients without (P< 0.001). Ln(ACR) was inversely correlated with ABI in all patients (gamma = - 0.198, P< 0. 01) and in separate sexes (gamma = - 0.211 for men and gamma = - 0.181 for women). The multivariate-adjusted odds ratios for PAD for every 1 unit increment of ln(ACR) was 1.66 (1. 17- 2.34); and for microalbuminuria versus normoalbuminuria and macroalbuminuria versus normoalbuminuria were 2.54 (1.05 -6.17) and 5.86 ( 1.76-19.52), respectively. Conclusions: urinary ACR is not only associated with PAD, it is also significantly correlated with ABI in an inverse pattern in elderly Taiwanese with T2DM