Proteinurin in diabetic patients effect on mortality

Aim: It is known that diabetes is a disease that shows a rapid increase both in the world and in Turkey due to lifestyle changes and causes many complications that increase the length of stay in hospitals. It is observed that each complication of diabetes requires serious treatment and consequently, the quality of life of patients becomes impaired and many related complications are irreversible. One of the most important complications is diabetic nephropathy. It is known that early treatment of proteinuria related to diabetic nephropathy is quite important as it slows down the deterioration in vital organ functions. It is necessary to understand the importance of investigating the cause of proteinuria and treating it early in patients who have existing proteinuria or are subsequently found to have proteinuria in patients followed up for diabetes. Numerous studies have reported the effect of proteinuria on mortality; however, the aim of the present study is to show the contribution of proteinuria to mortality in diabetic patients. Material and Method: The study included 80 patients, applied to the outpatient clinic of Nephrology between 2015 and 2021. Data of the patients such as laboratory values, clinical diagnoses, and drugs used were used from the files of the patients registered at the hospital system. Laboratory blood values (Urea, Creatinine, Gfr, Uric Acid, Sodium, Potassium, Magnesium, Calcium, Phosphorus, Albumin, Total Protein, Parathormon, Ferritin, TSH, LDL, Hba1c) spot urine (Spot Protein, Spot Microalbumin), and 24-hr urine values (Urinary clearance, Microprotein, Microalbumin) of the patients were examined from their files. In the present study, data regarding the dates and causes of deaths that occurred in the last 6 years were used in accordance with the patient's file information that are registered in the hospital system and DRS records. All the analyses were conducted by SPSS 21.0 package program and the value of p<0.05 was accepted as statistically significant. Results: The study included a total of 80 people. Within 6 years, 20 patients died and 60 patients were alive. The 20 decedent patients' mean 24-hr urine microprotein value was calculated as 1561.205 mg/day, mean 24-hr urinary microalbumin as 435.630 mg/day and mean spot urinary protein/creatinine rate as 133.2742 mg/dl, the 60 alive patients' mean 24- hr urinary microprotein was calculated as 2142.502, mean 24-hr urinary microalbumin as 544.907 mg/day, and mean spot urinary protein/creatinine rate as 156.4824 mg/dl. It was observed that quantity of proteinuria of the alive patients was higher than the decedent patients and effect of proteinuria on mortality was not found to be statistically significant in x diabetic patients (p>0.05). Then, the patients were divided in 3 groups according to their 24- hr urinary microprotein values as 1000 mg/day, 2000 mg/day, and 3000 mg/day. There was no significant difference between the patients with microprotein values above and below the values measured in these groups in terms of mortality. Among other parameters examined in the study, the factors affecting mortality were found as age (p=0.001), albumin (p=0.043), and Ferritin (p=0.001). While one-unit increase (1 year) in age increased the risk of mortality by 14.8%, one-unit increase in ferritin increases the risk of mortality by 1.5%. On the other hand, it was found that one-unit increase in albumin reduced the risk of mortality by approximately 96% (p=1- 0.043 = 0.957). Conclusion: In contrast to the studies and literature reporting that proteinuria has an effect on mortality, the effect of proteinuria on mortality was not shown in diabetic patients. However, the decrease in the amount of hemoglobin and albumin and the increase in ferritin values in the patients with diabetic proteinuria have an effect on mortality; therefore, it is seen that these values should be considered when arranging the treatment of these patients. Keywords: Proteinuria, mortality, albumin, diabetic nephropathy.