Aims: Serum ferritin has been found closely related with diabetes and glucose metabolism, but its impact on diabetic nephropathy remains unknown. This study aimed to explore the association between serum ferritin and microalbuminuria in Type 2 diabetes. Methods: Eight hundred and fifty-one subjects with Type 2 diabetes were selected from a cohort participating in a glycaemic control study in Taiwan in 2008. We used urine albumin:creatinine ratio to define microalbuminuria; serum ferritin was divided into quartiles for analysis. Logistic regression and trend tests were used to delineate the association between serum ferritin and microalbuminuria. Results: Subjects with diabetes with higher ferritin tended to have more metabolic disorders, higher high-sensitivity C-reactive protein and higher prevalence of microalbuminuria. Compared with those in the lowest quartile, subjects with diabetes in the highest ferritin quartile were 55% (P = 0.029) more likely to have microalbuminuria. After controlling for demographics, metabolic profiles and other inflammatory markers, the association between serum ferritin levels and microalbuminuria remained significant (P for trend < 0.001). This independent relationship was not changed either for those who had better glycaemic control or those who had not used an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Conclusions: The current study shows hyperferritinemia may be an independent risk factor of nephropathy in patients with Type 2 diabetes. What's new: A significant relationship has been found between serum ferritin and microalbuminuria, indicating that iron overload may be a risk factor of diabetic nephropathy. Although ferritin may be an inflammatory marker in addition to a measure of iron concentration, the newly discovered relationship between hyperferritinemia and microalbuminuria seems to be independent of other inflammatory biomarkers such as high-sensitivity C-reactive protein and white blood cell count.
