High‐Altitude Renal‐Metabolic Stress and Albuminuria in Hospitalized Patients With Diabetes in Tibet

AIM: To evaluate whether a study-defined high-altitude renal-metabolic stress phenotype is associated with albuminuria-related kidney involvement in hospitalized patients with diabetes in Tibet. METHODS: This retrospective cross-sectional study included 867 hospitalized patients with diabetes in Lhasa, Tibet. An exploratory HARS-like score was constructed from high hemoglobin, high red blood cell distribution width (RDW), high uric acid and hypertension. Albuminuria and macroalbuminuria were defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30 and ≥ 300 mg/g. Modified Poisson regression estimated adjusted prevalence ratios (PRs). RESULTS: Among 724 patients with ACR data, albuminuria and macroalbuminuria were present in 306 (42.3%) and 102 (14.1%). High exploratory HARS-like stress (score ≥ 2) was associated with albuminuria (PR 1.70, 95% confidence interval [CI], 1.38-2.08) and macroalbuminuria (PR 2.82, 95% CI, 1.84-4.33) after adjustment for age, sex, diabetes duration, body mass index, HbA1c and fasting plasma glucose. Severe stress (score ≥ 3) showed a stronger association with macroalbuminuria. Results were broadly consistent after estimated glomerular filtration rate adjustment, alternative score definitions and extended available-confounder adjustment. High hemoglobin with high RDW identified a subgroup with greater albuminuria burden. CONCLUSIONS: In hospitalized patients with diabetes in Tibet, clustering of erythrocyte abnormality, hyperuricemia, and hypertension was associated with albuminuria-related kidney involvement, especially macroalbuminuria. External validation is needed.