Association Between Iron Metabolism and Microalbuminuria in Patients With Type 2 Diabetes Mellitus and MASLD.

OBJECTIVE: To investigate the association between iron metabolism markers and microalbuminuria in patients with Type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: A total of 137 patients with T2DM and MASLD were enrolled and stratified into microalbuminuria-positive and microalbuminuria-negative groups based on the urinary albumin-to-creatinine ratio (UACR). Iron metabolism markers, including serum ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation (TS), and hepcidin, were measured. Hepatic iron and fat content were assessed using magnetic resonance imaging (MRI), including R2∗ mapping (MRI-R2∗) and proton density fat fraction (MRI-PDFF). RESULTS: Patients with microalbuminuria had significantly higher levels of serum ferritin, serum iron, hepcidin, and MRI-R2∗ compared with those without microalbuminuria (all p < 0.05). Correlation analyses showed that hepcidin (r s = 0.208, p = 0.015) and MRI-R2∗ (r s = 0.248, p = 0.003) were positively associated with UACR. However, after multivariable adjustment for confounding factors, MRI-R2∗ remained independently associated with microalbuminuria (p = 0.049). CONCLUSIONS: Altered iron metabolism is associated with microalbuminuria in patients with T2DM and MASLD. MRI-R2∗, a quantitative imaging marker of hepatic iron content, showed an independent association with microalbuminuria after multivariable adjustment and may provide complementary information for early renal injury assessment in this population.