{
  "abstract": "Background: Studies of routine blood markers and diabetic retinopathy often adjust for estimated glomerular filtration rate (eGFR), although albuminuria captures a different aspect of kidney damage. We compared these associations under eGFR and urinary albumin-to-creatinine ratio (UACR) adjustment.\n\nMethods: We analyzed 8,159 adults hospitalized with type 2 diabetes from January 2020 to March 2026. Primary exposures were serum albumin, total bilirubin, fibrinogen and the FIB-4 index. Four models were fitted in a fixed complete-case sample, with additional adjustment for eGFR, log UACR, or both. The outcome was documented diabetic retinopathy (DR), based on ophthalmological assessment and discharge diagnosis; DR = 0 included unassessed patients without a DR diagnosis. Prevalence ratios were estimated by marginal standardization.\n\nResults: Among 3,978 complete-case patients, 958 (24.1%) had documented DR. Adjustment for log UACR attenuated the serum albumin association more than adjustment for eGFR (73.3% versus 34.3%; difference 38.9 percentage points, 95% CI 30.7 to 49.0) and moved the fibrinogen estimate close to one. Binary albuminuria produced substantially less attenuation than continuous log UACR. Multiple imputation supported the renal-adjustment comparison, although the albumin interval included the null after mutual renal adjustment. Serum albumin remained associated with documented DR after restriction to eGFR ≥90 mL/min/1.73 m ² (prevalence ratio 0.762, 95% CI 0.649 to 0.873), whereas no clear evidence of an eGFR association was observed within this stratum (0.981, P = 0.823). Conclusions: In this single-center inpatient cohort, eGFR and UACR adjustment yielded different estimates for the studied blood-marker associations with documented DR. Attenuation denotes proportional reduction in the absolute log prevalence-ratio estimate, not a causal proportion explained. Dichotomizing UACR discarded information and reduced attenuation in these models.",
  "abstract_shown": true,
  "affiliations": [
    "The Second Clinical College of Guangzhou University of Chinese Medicine",
    "Department of Ophthalmology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jing Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Mingliang Xu"
    },
    {
      "affs": [
        0
      ],
      "name": "Baoyi Xiong"
    },
    {
      "affs": [
        1
      ],
      "name": "Baohua Luo"
    },
    {
      "affs": [
        1
      ],
      "name": "Long Pang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c2dgm0d8xx5xs.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1983060",
  "fulltext_url": null,
  "id": "c2dgm0d8xx5xs",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1983060/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2727|Chronic Kidney Disease and Diabetes"
    ]
  ],
  "openalex": "W7223832115",
  "pdf_url": "https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2026.1983060/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-27",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/c2dgm0d8xx5xs.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1983060",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1983060/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2392",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "UACR adjustment attenuates associations of selected routine blood markers with documented diabetic retinopathy more than eGFR adjustment: a cross-sectional study in type 2 diabetes",
  "title_text": "UACR adjustment attenuates associations of selected routine blood markers with documented diabetic retinopathy more than eGFR adjustment: a cross-sectional study in type 2 diabetes",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/c2dgm0d8xx5xs",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}