Albuminuria and progression of cardiac structural and functional abnormalities in adults with type 2 diabetes in Kenya: the MOYO-FIGO study protocol

Background Type 2 diabetes mellitus (T2DM) is associated with increased risk of cardiovascular and kidney complications. Albuminuria is an established marker of diabetic kidney involvement and is increasingly recognized as a marker of cardiovascular risk. Cardiac structural and functional abnormalities may occur before overt heart failure, but longitudinal African data linking albuminuria to progression of echocardiographic abnormalities remain limited. The Myocardial Outcomes over Years Observed with Functional Imaging and Glomerular Outcomes (MOYO-FIGO) study was designed to evaluate whether albuminuria predicts progression of cardiac structural and functional abnormalities among adults with T2DM in Kenya. Methods and analysis MOYO-FIGO is a prospective observational cohort study describing the longitudinal follow-up of an established cohort with completed baseline cardio-kidney-metabolic (CKM) phenotyping and planned two-year follow-up. Adults aged 40 years or older with T2DM attending the Kenyatta National Hospital outpatient diabetes clinic in Nairobi, Kenya, were enrolled. Baseline assessment included socio-demographic and clinical data, blood pressure, anthropometry, laboratory testing, urinary albumin-to-creatinine ratio (UACR), electrocardiography, and comprehensive transthoracic echocardiography, including global longitudinal strain (GLS). Participants will be invited for repeat clinical, laboratory, urinary, and echocardiographic assessment two years after baseline. The primary longitudinal outcome is two-year change in GLS. Secondary outcomes include incident or progressive echocardiographic abnormalities, including left ventricular hypertrophy, left atrial enlargement, reduced left ventricular ejection fraction, left ventricular diastolic dysfunction, right ventricular systolic dysfunction, and any predefined echocardiographic abnormality. Ethics and dissemination Ethical approval for the baseline MOYO-FIGO assessment was obtained from the Kenyatta National Hospital–University of Nairobi Ethics Review Committee, approval number P713/09/2024. MOYO-FIGO will generate context-specific longitudinal evidence on the relationship between albuminuria, cardiac remodeling, myocardial dysfunction, and CKM progression in adults with T2DM. Findings will be disseminated through peer-reviewed publications, scientific conferences, and presentations to relevant clinical and academic stakeholders.