High‐Altitude Renal‐Metabolic Stress and Albuminuria in Hospitalized Patients With Diabetes in Tibet
Zhining Zhang, Hiroshi Seno, Lihui Yang, Hiroshi KondohABSTRACT
Aim
To evaluate whether a study‐defined high‐altitude renal‐metabolic stress phenotype is associated with albuminuria‐related kidney involvement in hospitalized patients with diabetes in Tibet.
Methods
This retrospective cross‐sectional study included 867 hospitalized patients with diabetes in Lhasa, Tibet. An exploratory HARS‐like score was constructed from high hemoglobin, high red blood cell distribution width (RDW), high uric acid and hypertension. Albuminuria and macroalbuminuria were defined as urinary albumin‐to‐creatinine ratio (ACR) ≥ 30 and ≥ 300 mg/g. Modified Poisson regression estimated adjusted prevalence ratios (PRs).
Results
Among 724 patients with ACR data, albuminuria and macroalbuminuria were present in 306 (42.3%) and 102 (14.1%). High exploratory HARS‐like stress (score ≥ 2) was associated with albuminuria (PR 1.70, 95% confidence interval [CI], 1.38–2.08) and macroalbuminuria (PR 2.82, 95% CI, 1.84–4.33) after adjustment for age, sex, diabetes duration, body mass index, HbA1c and fasting plasma glucose. Severe stress (score ≥ 3) showed a stronger association with macroalbuminuria. Results were broadly consistent after estimated glomerular filtration rate adjustment, alternative score definitions and extended available‐confounder adjustment. High hemoglobin with high RDW identified a subgroup with greater albuminuria burden.
Conclusions
In hospitalized patients with diabetes in Tibet, clustering of erythrocyte abnormality, hyperuricemia, and hypertension was associated with albuminuria‐related kidney involvement, especially macroalbuminuria. External validation is needed.