title: Cross-sectional associations of albuminuria and C-reactive protein with functional disability in older adults with diabetes.
abstract: OBJECTIVE
  To examine the relationship between albuminuria, inflammation, and disability in older adults with diabetes.
  
  
  METHODS
  Data were from 1,729 adults (≥ 60 years) with diabetes in the National Health and Nutrition Examination Survey, 1999-2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) was obtained from self-reports. Urinary albumin-to-creatinine ratio (UACR) (mg/g) was categorized into normal (UACR <30 mg/g), microalbuminuria (UACR 30-300 mg/g), and macroalbuminuria (UACR >300 mg/g). C-reactive protein (CRP) levels were quantified by latex-enhanced nephelometry.
  
  
  RESULTS
  In the full-adjusted model, microalbuminuria was associated with disability in ADL, LSA, and LEM with corresponding odds ratios (ORs) (95% CIs) of 1.51 (1.16-1.98), 1.62 (1.23-2.14), and 1.34 (1.03-1.74), respectively, compared with participants without albuminuria. Macroalbuminuria was associated with disability in ADL, IADL, and LEM with corresponding ORs (95% CIs) of 1.94 (1.24-3.03), 1.93 (1.23-3.02), and 2.20 (1.38-3.49), respectively, compared with participants without albuminuria. Elevated CRP (>0.3 mg/dL) was associated with increased odds of disability in ADL and LEM, with corresponding ORs (95% CIs) of 1.28 (1.00-1.62) and 1.68 (1.34-2.11), respectively. Subjects with both albuminuria and elevated CRP had higher odds of disability than individuals with no albuminuria and normal CRP.
  
  
  CONCLUSIONS
  Albuminuria and inflammation were independent correlates for disability among older adults with diabetes. There was an interaction of albuminuria and elevated CRP on disability, suggesting that the presence of subclinical inflammation may amplify the effect of albuminuria on disability in older adults living with diabetes.
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA. hskuo@utmb.edu
authors.forename: Hsu-Ko
authors.initials: HK
authors.lastname: Kuo
authors.forename: Soham
authors.initials: S
authors.lastname: Al Snih
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Mukaila A
authors.initials: MA
authors.lastname: Raji
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio
chemical_list: D002097:C-Reactive Protein