Clinical, inflammatory, and cardiovascular correlates of microalbuminuria in a Zambian cohort

Abstract

Microalbuminuria is an early indicator of renal and systemic vascular injury and a predictor of cardiovascular risk, particularly in individuals with cardiometabolic conditions. Its occurrence is influenced by demographic and metabolic factors and reflects underlying endothelial dysfunction. However, its relationship with inflammatory and hormonal biomarkers remains insufficiently understood, especially across diverse populations. Therefore, this study aimed to assess the association between microalbuminuria and its clinical, inflammatory, and cardiovascular profiles. This was a cross-sectional study among adults attending medical clinic at Livingstone University Teaching Hospital between 01 October 2023 and 01 June 2024. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio of 30–299 mg/g. Demographic and clinical variables were collected. Modified poisson logistic regression with robust variance was performed to identify factors associated with microalbuminuria, with results reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Of the 277 study participants, the majority were female ( n = 194, 70.0%), with a median age of 49 years (IQR 40–59). The prevalence of microalbuminuria was 35.0% (97/277; 95% CI 29.4–40.6%). After adjustment for age, body mass index, and HIV status, increasing age was independently associated with a higher prevalence of microalbuminuria (aPR = 1.02; 95% CI 1.00–1.03; p = 0.048), higher IL-17 A levels (aPR = 1.00; 95% CI 1.00–1.00; p < 0.001), soluble suppression of tumorigenicity-2 (sST2) (aPR = 1.01; 95% CI 1.00–1.02; p = 0.039), and white blood cell count (aPR = 1.09; 95% CI 1.03–1.15; p = 0.003). Conversely, right ventricular dimension at diastole (RVD) was associated with a lower prevalence of microalbuminuria (aPR = 0.44; 95% CI 0.25–0.79; p = 0.006). HIV status, employment, history of tuberculosis, hypertension, BMI, renin, angiotensin II, and aldosterone were not independently associated with microalbuminuria after adjustment. Microalbuminuria was highly prevalent in this population and was significantly associated with increasing age, and RVD. These findings support the role of microalbuminuria as an early marker of cardiorenal risk and highlight the importance of routine screening, particularly among older individuals with cardiometabolic risk factors. Further longitudinal studies are needed to clarify causal pathways and evaluate the prognostic significance of these associations in similar settings.