Renal Outcomes and Prognostic Factors in Patients with Type-2 Diabetes and Chronic Kidney Disease Confirmed by Renal Biopsy

Overview

Journal Ther Adv Chronic Dis

Publisher Sage Publications

Date 2021 Nov 3

PMID 34729158

Citations 4

Authors

Na Jing

Mengxing Pan

Yi Song

Feng Guo

Haohao Zhang

Jiao Wang

Zhe Cao

Shiyu Liu

Lina Wu

Hongfei Ji

Fengjuan Huang

Xiaoxu Ding

Chang Qi

Sen Huang

Xinyu Yang

Li Zhang

Chunhua Song

Guijun Qin

Yanyan Zhao

Affiliations

Soon will be listed here.

Abstract

Aim: To evaluate the renal outcomes and prognostic factors among patients with type-2 diabetes (T2D) and biopsy-confirmed diabetic nephropathy (DN), non-diabetic renal disease (NDRD) and DN mixed with NDRD (MIX).

Design And Methods: Patients with both T2D and chronic kidney disease (CKD) who underwent renal biopsy between January 2014 and December 2016 were recruited in this prospective observational study. Participants were divided into DN group, NDRD group, or MIX group according to the baseline pathological diagnosis. The primary endpoint was a composite renal event of end-stage renal disease (ESRD) or ⩾ 40% reduction in estimated glomerular filtration rate (eGFR).

Results: Among the 292 participants included, 153 (52.4%) belonged to the DN group, 30 (10.3%) belonged to the NDRD group, and 109 (37.3%) belonged to the MIX group. During the median follow-up of 27 months, the adverse renal events occurred in 132 (44.2%) patients. Compared with NDRD group, the multiple adjusted hazard ratios (HRs) for renal events in patients with DN and MIX groups were 3.900 (95% confidence interval [CI]: 1.103-13.788) and 2.691 (95% CI: 0.662-10.936), respectively. Baseline lower eGFR (HR: 1.159, 95% CI: 1.060-1.266), severe proteinuria (HR: 2.047, 95% CI: 1.227-3.416), lower hemoglobin (HR: 1.170, 95% CI: 1.008-1.267), and a family history of diabetes (HR: 1.138, 95% CI: 1.008-2.285) were independent predictors for adverse renal outcomes in patients with DN.

Conclusion: In patients with T2D and CKD, pure DN and MIX group displayed a worse renal prognosis than NDRD group. Worse renal function, severe proteinuria, lower hemoglobin, and a family history of diabetes may be associated with adverse renal outcomes in patients with DN.

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References

Di Paolo S, Fiorentino M, De Nicola L, Reboldi G, Gesualdo L, Barutta F . Indications for renal biopsy in patients with diabetes. Joint position statement of the Italian Society of Nephrology and the Italian Diabetes Society. Nutr Metab Cardiovasc Dis. 2020; 30(12):2123-2132. DOI: 10.1016/j.numecd.2020.09.013. View

Iwai T, Miyazaki M, Yamada G, Nakayama M, Yamamoto T, Satoh M . Diabetes mellitus as a cause or comorbidity of chronic kidney disease and its outcomes: the Gonryo study. Clin Exp Nephrol. 2017; 22(2):328-336. DOI: 10.1007/s10157-017-1451-4. View

New J, Aung T, Baker P, Yongsheng G, Pylypczuk R, Houghton J . The high prevalence of unrecognized anaemia in patients with diabetes and chronic kidney disease: a population-based study. Diabet Med. 2008; 25(5):564-9. DOI: 10.1111/j.1464-5491.2008.02424.x. View

Liu S, Guo Q, Han H, Cui P, Liu X, Miao L . Clinicopathological characteristics of non-diabetic renal disease in patients with type 2 diabetes mellitus in a northeastern Chinese medical center: a retrospective analysis of 273 cases. Int Urol Nephrol. 2016; 48(10):1691-8. PMC: 5031732. DOI: 10.1007/s11255-016-1331-y. View

Anders H, Huber T, Isermann B, Schiffer M . CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018; 14(6):361-377. DOI: 10.1038/s41581-018-0001-y. View

Mehdi U, Toto R . Anemia, diabetes, and chronic kidney disease. Diabetes Care. 2009; 32(7):1320-6. PMC: 2699743. DOI: 10.2337/dc08-0779. View

Zhuo L, Zou G, Li W, Lu J, Ren W . Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus. Eur J Med Res. 2013; 18:4. PMC: 3598553. DOI: 10.1186/2047-783X-18-4. View

Umanath K, Lewis J . Update on Diabetic Nephropathy: Core Curriculum 2018. Am J Kidney Dis. 2018; 71(6):884-895. DOI: 10.1053/j.ajkd.2017.10.026. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

10.

Wright L, Hirsch I . Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters. Diabetes Technol Ther. 2017; 19(S2):S16-S26. PMC: 5444503. DOI: 10.1089/dia.2017.0029. View

11.

Berger M, Monks D, Wanner C, Lindner T . Diabetic nephropathy: an inherited disease or just a diabetic complication?. Kidney Blood Press Res. 2003; 26(3):143-54. DOI: 10.1159/000071880. View

12.

Fiorentino M, Bolignano D, Tesar V, Pisano A, Van Biesen W, Tripepi G . Renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies. Nephrol Dial Transplant. 2016; 32(1):97-110. DOI: 10.1093/ndt/gfw070. View

13.

Khoshdel A, Carney S, Gillies A, Mourad A, Jones B, Nanra R . Potential roles of erythropoietin in the management of anaemia and other complications diabetes. Diabetes Obes Metab. 2007; 10(1):1-9. DOI: 10.1111/j.1463-1326.2007.00711.x. View

14.

Popa O, Stefan G, Capusa C, Mandache E, Stancu S, Petre N . Non-diabetic glomerular lesions in diabetic kidney disease: clinical predictors and outcome in an Eastern European cohort. Int Urol Nephrol. 2020; 53(4):739-747. DOI: 10.1007/s11255-020-02681-x. View

15.

Oh S, Kim S, Na K, Chae D, Kim S, Jin D . Clinical implications of pathologic diagnosis and classification for diabetic nephropathy. Diabetes Res Clin Pract. 2012; 97(3):418-24. DOI: 10.1016/j.diabres.2012.03.016. View

16.

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

17.

Wong T, Choi P, Szeto C, To K, Tang N, Chan A . Renal outcome in type 2 diabetic patients with or without coexisting nondiabetic nephropathies. Diabetes Care. 2002; 25(5):900-5. DOI: 10.2337/diacare.25.5.900. View

18.

Li L, Zhang X, Li Z, Zhang R, Guo R, Yin Q . Renal pathological implications in type 2 diabetes mellitus patients with renal involvement. J Diabetes Complications. 2016; 31(1):114-121. DOI: 10.1016/j.jdiacomp.2016.10.024. View

19.

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33 Suppl 1:S62-9. PMC: 2797383. DOI: 10.2337/dc10-S062. View

20.

Ito K, Yokota S, Watanabe M, Inoue Y, Takahashi K, Himuro N . Anemia in Diabetic Patients Reflects Severe Tubulointerstitial Injury and Aids in Clinically Predicting a Diagnosis of Diabetic Nephropathy. Intern Med. 2020; 60(9):1349-1357. PMC: 8170246. DOI: 10.2169/internalmedicine.5455-20. View