Ann Biol Clin (Paris). 2026 Oct 12;84(5):0. doi: 10.1684/abc.2026.2065. Online ahead of print.
ABSTRACT
Diabetic nephropathy is the leading cause of end-stage chronic kidney disease worldwide. Albuminuria, assessed by the urinary albumin-to-creatinine ratio (ACR), is an independent marker of both renal prognosis and cardiovascular risk. To assess the correlation between HbA1c and ACR in diabetic patients with an eGFR ≥ 60 mL/min/1.73 m² and to determine the prevalence of pathological albuminuria in this population. A retrospective case-control study conducted from June 2023 to June 2026. Cases were diabetic patients (HbA1c ≥ 6.5%) and controls were non-diabetic subjects (HbA1c < 5.7%), all with an eGFR ≥ 60 mL/min/1.73 m² (KDIGO stages G1: ≥ 90 and G2: 60-89) and an available ACR measurement. Albuminuria was classified according to KDIGO as A1 (< 30 mg/g), A2 (30-300 mg/g) and A3 (> 300 mg/g). eGFR was calculated using the CKD-EPI 2021 equation. Statistical analysis used Spearman, Mann-Whitney and Chi² tests. Four hundred and twenty subjects were included: 232 diabetic patients and 188 non-diabetic controls. The prevalence of pathological albuminuria was significantly higher in diabetic patients than in controls (44.0% vs. 21.3%; p < 0.0001), as was the median ACR (23.5 vs. 9.0 mg/g; p < 0.0001). Within the diabetic group, no significant correlation was found between HbA1c and ACR (Spearman r = 0.016; p = 0.814). In contrast, ACR was significantly higher in stage G2 than in stage G1: 33.5 vs. 15,0 mg/g (p = 0.003), and increased with age (r = 0.169; p = 0.010). This study reveals a high prevalence of pathological albuminuria in diabetic patients with an eGFR ≥ 60 mL/min/1.73 m². Point HbA1c does not predict the degree of albuminuria, whereas eGFR stage and age are its main biological determinants. These findings support an integrated biological approach combining ACR and eGFR with HbA1c monitoring.
PMID:42862638 | DOI:10.1684/abc.2026.2065