International Journal of Novel Research in Healthcare and Nursing

Vol. 8, Issue 3, pp: (16-23), Month: September - December 2021

RENAL FUNCTION ON THE BASIS SERUM UREA AND CREATININE IN DIABETIC AND
NONDIABETIC PERSONS IN A TERTIARY TEACHING HOSPITAL

OHIRI J. U.1 and OWAMAGBE E. M.2

1 Department of Chemical Pathology, Federal medical center, Owerri, Imo state, Nigeria.

2 Department of Chemical Pathology, College of Medicine, Rivers state University, Rivers state, Nigeria

ABSTRACT
Type-2 diabetes mellitus (T2DM) has quickly become a global health problem due to rapidly increasing
population growth, aging, urbanization and increasing prevalence of obesity and physical inactivity. T2DM
is also the major cause of renal morbidity and mortality and a common cause of renal injury. This study
was carried out to measure serum creatinine and urea levels in diabetes and non-diabetic samples and to
establish relationship of blood sugar level with urea and creatinine levels. The study was carried out in a
tertiary healthcare institution where 120 diabetic persons and 120 non-diabetic persons were selected. The
serum Urea and Creatinine levels of these groups of persons was assessed using standard methods. Analysis
of the data showed that HBA1c, urea, creatinine and eGFR was found to be higher in the diabetic subjects
compared to the control subjects. There was a positive correlation of urea and creatinine with HBA1c (r =
0.05 and 0.02 respectively) among non-diabetic persons. However, the correlations were not statistically
significant. The results also show a positive correlation of urea and creatinine with HBA1c (r= 0.26 and
0.15 respectively among diabetic persons. However, only the correlation of urea and HBA1c was found to
be statistically significant (p <0.05). The findings of the study indicate that the pathophysiology of Type 2
Diabetes Mellitus (T2DM) corresponds to the elevated expression of serum urea and creatinine. The
expression of these substances could lead to a poor sequalae of T2DM if unchecked. Regulating levels of
urea and creatinine among diabetics could help improve the prognosis of the disease.

Keywords: Urea, Creatinine Diabetes Mellitus, Nephropathy

INTRODUCTION
Diabetic mellitus (DM) is a group of metabolic disorder of carbohydrate metabolism in which
glucose is under used, producing hyperglycemia. Different statistics have led to diabetes being
described as one of the main threats to human health in the 21st century(1,2). Type-2 diabetes
mellitus has quickly become a global health problem due to rapidly increasing population growth,
aging, urbanization and increasing prevalence of obesity and physical inactivity(3,4). There is,
therefore, an urgent need to prevent diabetes and its complications. Diabetes is the major cause of
end stage renal disease (ESRD) both in Nigeria and around the world and has enormous medical,
social and economic consequences(1,5). DM is also the major cause of renal morbidity and
mortality(2,6). Diabetes is the most common cause of kidney failure, accounting for nearly 44
percent of new cases(7). Even when diabetes is controlled, the disease can lead to chronic kidney
disease (CKD) and kidney failure. Kidney failure is the final stage of chronic kidney disease.
Nearly 6 million people in the Nigeria have diabetes and nearly 180,000 people are living with
kidney failure as a result of diabetes(8). Diabetic nephropathy occurs approximately in one third
type-2 diabetic patients and is on rise(1). In diabetic nephropathy a number of serum markers are
known to be deranged with significant morbidity and mortality(9). Urea and creatinine are the
parameters to diagnose functioning of the kidney. Changes in serum creatinine concentration more
reliably reflect changes in GFR than do changes in serum urea concentrations. Creatinine is formed
spontaneously at a constant rate from creatinine and blood concentrations depend almost solely
upon GFR. Urea formation is influenced by a number of factors such as liver function, protein

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intake and rate of protein catabolism(2,10). Measurement of the plasma urea and creatinine is
widely regarded as a test of renal function and serum albumin was an independent risk factor in
patients with ESRD(11). The aim of our study is to measure serum creatinine and urea levels in
diabetes and non-diabetic samples and to establish relationship of blood sugar level with urea and
creatinine levels.

METHODS
Study Area
The study was conducted at the diabetic clinic of the University of Port Harcourt Teaching
Hospital, Port Harcourt, Rivers state. It is a tertiary health care facility with about 500 beds and
serves as a major referral center in Rivers State with clinics all through the week.
Study Population and Sample
The study population consists of type 2 diabetes patients and non-diabetic attending the University
of Port Harcourt Teaching Hospital, Port Harcourt, Rivers state. Two groups of individuals were
recruited into the study as follows; Group A – Type II diabetes mellitus subjects, Group B – Non
diabetes patients as controls. The group A and group B will be age and sex matched.
The sample size for the study was determined from the formula.(12)
n =Z2pq
d2
where ;
n = sample size for Case and Control
Z = 95% confidence interval= 1.96
P = proportion of the target population used=6.8%(13)
q = 1.0 – p = 1.0 - 0.068 = 0.932

d = degree of accuracy desired (usually set at 0.05)

n = {(1.96)2 (0.068) (1.0 - 0.068)}
0.052

={3.841 × 0.068× 0.932}

0.0025

=97.4 Approximately 97
However taking into consideration that some patients may opt out in the course of the study, an
attrition rate of 10% was used.
97 × 10 = 9.7, Approximately 10
100
= this gives a minimum sample size of 97 + 10
= 107
Therefore, a projection of 110 study participants (with type II diabetes) and 110 apparently healthy
participants as control, giving a total of 220 participants were used for the study. Sequence generation
randomization method was employed in this study such that all eligible study participants were recruited
from the diabetic clinic of the University of Port Harcourt teaching Hospital on a daily basis over a
period of three months to obtain the required sampling frame and the control of 120 participants each.
Ethical Consideration

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Approval for the study was obtained from ethical committee of University of Port Harcourt
Teaching Hospital and willing informed consent obtained from each participant.

Data collection
A study questionnaire was used and it dealt with socio- demographic variables, risk factors for
type II DM, including past medical histories and information on clinical and laboratory variables.
Specimen collection and analysis
Ten milliliters (10mls) of fasting venous blood was collected by venipuncture from the antecubital
vein of each study participant. 5mls of venous whole blood was transferred into a well labelled
plain specimen tube where it was allowed to clot for at least 60 minutes undisturbed at room
temperature. The separated serum was stored frozen immediately at -200C until it was subjected
to urea assessment using Elabscience Enzyme-linked Immunosorbent assay according to
Manufacturers Instruction. Creatinine expression was estimated using the modified Jaffe method
(kinetic methods).
Data Analysis
Data obtained was analyzed using standard statistical methods with the statistical package for
social science (SPSS Version 25). Differences of the mean urea and creatinine levels between
diabetics and non-diabetics was compared using the students’ t-test. A p-value equal or lower than
0.05 was taken to be significant. A Pearson Correlation Coefficient was used to determine the
association between urea, creatinine and HBA1c.
RESULTS

Table 1: Socio-demographic Data

Variables Control Subject Chi-square

n = 120 (%) n = 120 (%) (p-value)
Gender
Male 60 (50.0) 60 (50.0) 0.00 (1.000)**
Female 60 (50.0) 60 (50.0)
Age
Mean age± SD 47.9 ±11.5 44.7 ± 11.7
**Difference is not statistically significant (p > 0.05)

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Table 2: Serum levels of biochemical parameters

Subject Control t-test

(n=120) (n=120)
HBA1C (%) 9.42 ±2.27 5.14 ±0.81 0.001*
FPG (mmol/l) 11.18 ±3.0 5.36 ±0.81 0.001*
Urea (µmol/l) 4.40 ±1.10 3.76 ±0.61 0.001*
Creatinine (µmol/l) 99.08 ±40.31 76.96 ±11.9 0.001*
eGFR (ml/min) 84.4 ±25.3 108.06 ±23.5 0.001*
All values are presented in mean ±standard deviation
FPG: Fasting plasma glucose; eGFR: Estimated glomerular filtration rate.
*Difference is statistically significant (p <0.05),
The table shows the T-test comparison of the average serum levels of the biochemical parameters
between the diabetic subjects and healthy control subjects. The table showed a significant
difference in the average serum levels of all biochemical markers measured between both groups.
The, HBA1c, urea, creatinine and eGFR was found to be higher in the diabetic subjects compared
to the control subjects.

UR CR Linear (UR) Linear (CR)

140
120
Urea and Creatinine

100 r=0.05, p =0.547

80
60
40
20 r=0.25, p =0.790
0
0 1 2 3 4 5 6 7 8
HBA1c
Figure 1: Correlation of Urea and Creatinine with HBA1c in non-
diabetic persons

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UR CR Linear (UR) Linear (CR)

150
130
Urea and Creatinine

110
r=0.15, p =0.089
90
70
50
30
r=0.26, p =0.003
10
-10 0 2 4 6 8 10 12 14 16 18
HBA1c

Figure 2: Correlation of Urea and Creatinine with HBA1c in

diabetic persons

Figure 1 shows a positive correlation of urea and creatinine with HBA1c (r = 0.05 and 0.02 respectively)
among non-diabetic persons. However, the correlations were not statistically significant. Figure 2 also
shows a positive correlation of urea and creatinine with HBA1c (r= 0.26 and 0.15 respectively among
diabetic persons. However, only the correlation of urea and HBA1c was found to be statistically significant
(p <0.05).

DISCUSSION
Impairment of renal function due to type 2 diabetes mellitus was assessed by measurement of
plasma concentrations of creatinine and urea in both tests (diabetic subjects and non-diabetic
controls). The plasma creatinine and urea are established markers of GFR, though plasma
creatinine is a more sensitive index of kidney function. An increase in urea level is seen among
diabetics indicating that the kidney is not functioning properly. Increment of blood urea level with
the increment of blood sugar level clearly indicates that the increase blood sugar level causes

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damage to the kidney. Previous research conducted had found that increase urea and serum
creatinine in diabetic rats indicates progressive renal damage(3,4).
There was a stronger correlation of the serum urea and creatinine with HBA1c among diabetic
persons compared to non-diabetic persons as indicated in the findings of the current study.
Lowering Serum Uric Acid (SUA) has also been reported to reduce renal injury and improve renal
function in mice with T2DM(14–16). So far, however, evidence that pharmacologic reduction of
SUA may affect the course of DKD is missing despite some preliminary and encouraging evidence
from pilot studies(17–19). Interestingly, with the exception of patients with a relatively short
duration of disease, the role of SUA as in- dependent risk factor for the development of CKD was
evident in all patient subgroups. In particular study, higher SUA was significantly associated to
eGFR,60 ml/min per 1.73 m2 at 4-year follow-up independently of sex, BMI, glycometabolic
profile, BP, and microvascular damage (such as hyperfiltration or retinopathy), suggesting that the
data presenting herein are consistent with a possible pathogenetic pathway linking SUA to the
development of DKD in several clinical conditions(20–24). Our observations we found blood
glucose concentration, plasma creatinine and urea concentrations were observed to be significantly
higher in type-2 DM subject males and females were in accordance with the other studies which
showed raised plasma creatinine and urea levels in diabetic patients may indicate a pre-renal
problem(1,2,8,9). Diabetic nephropathy, especially related to type-2 diabetes, has become the
single most important cause of ESRD (end stage renal disease) worldwide. Management of
traditional risk factors such as hyper tension, hyperlipidemia, and smoking to improve
cardiovascular and renal outcomes continues to be important in patients with chronic kidney
disease.
CONCLUSION
The findings of the study indicate that the pathophysiology of Type 2 Diabetes Mellitus (T2DM)
corresponds to the elevated expression of serum urea and creatinine. The expression of these
substances could lead to a poor sequalae of T2DM if unchecked. Regulating levels of urea and
creatinine among diabetics could help improve the prognosis of the disease.
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