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 ABI<0.9, and ACR was divided into normoalbuminuria (30.0 μg/mg), microalbuminuria (30.0 ± 299.9 μg/mg), and macroalbuminuria (≥ 300.0 μg/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 (γ = -0.198, P < 0.01) and in separate sexes (γ = -0.211 for men and γ = -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.