The Renal Micro-Vasculopathy and Systemic Aldosterone-Renin Ratio (ARR) in Type 2 Diabetic Patients—A Retrospective Real-World Study

Song Wen,1,2,* Zhimin Xu,1,* Min Gong,1,* Congcong Wang,1 Yue Yuan,1 Yanyan Li,1 Meiyuan Dong,1 Chaoxun Wang,1 Dongxiang Xu,1 Xinlu Yuan,1 Ligang Zhou1,2 1Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, 201399, People’s Republic of China; 2Fudan Zhangjiang Institute, Fudan University, Shanghai, 201203, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ligang Zhou, Department of Endocrinology;Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China, Tel +8613611927616, Email [email protected]: To investigate whether the imbalanced aldosterone to renin ratio (ARR) is associated with renal micro-vasculopathy in type 2 diabetes mellitus (T2DM).Materials and Methods: Data from 471 T2DM patients were retrospectively analyzed from 2019 to 2023. Blood samples were collected for hypertensive and diabetes-related parameters at the time of admission. The patients were divided into two groups based on laboratory measurement methods: plasma renin concentration or plasma renin activity.Results: This study found that dividing patients into four quartiles showed significant increases in renal microvascular damage, measured by serum creatinine (SCr) and blood urea nitrogen (BUN), in contrast to the decline pattern of cystatin C (Cys) in the highest and lowest quartiles of ARR, respectively. This pattern contrasted with the levels of the urinary albumin-to-creatinine ratio (UACR) and the estimated glomerular filtration rate (eGFR). Correlation analysis identified gender, systolic blood pressure (SBP), and kidney function markers as significantly associated with ARR. Women exhibited the highest levels of renin or aldosterone. Furthermore, multilinear regression analysis in the PDC group indicated that ARR was independently influenced by insulin requirement, antihypertensive medication, serum magnesium, diastolic blood pressure (DBP), thyroid hormone, and calcium balance. In the PRA group, glucose metabolism, calcium homeostasis, and bile acids affect ARR change. The receiver operating characteristic (ROC) curve demonstrated that ARR could serve as a predictor of renal function and UACR.Conclusion: The results indicated that the aberrant ARR was associated with renal glomerular injury. ARR can be employed to examine the relationship between renal injury and renin-angiotensin-aldosterone system (RAAS) activity.Keywords: T2DM, ARR, renal function, eGFR, UACR