Risk factors for non-diabetic renal disease in diabetic patients
Sheila Bermejo 1 2 , Ester González 3 , Katia López-Revuelta 4 , Meritxell Ibernon 5 , Diana López 6 , Adoración Martín-Gómez 7 , Rosa Garcia-Osuna 8 , Tania Linares 9 , Montserrat Díaz 10 , Nàdia Martín 11 , Xoana Barros 11 , Helena Marco 12 , Maruja Isabel Navarro 12 , Noemí Esparza 13 , Sandra Elias 14 , Ana Coloma 15 , Nicolás Roberto Robles 16 , Irene Agraz 17 , Esteban Poch 18 19 , Lida Rodas 18 19 , Víctor Lozano 18 19 , Beatriz Fernández 20 , Eduardo Hernández 3 , Maria Isabel Martínez 4 , Ramona Ionela Stanescu 4 , José Pelayo Moirón 6 , Núria García 6 , Marian Goicoechea 9 , Francesca Calero 10 , Josep Bonet 12 , Josep M Galceran 2 , Fernando Liaño 14 , Julio Pascual 1 , Manuel Praga 3 , Xavier Fulladosa 21 , María José Soler 1 17
Background: Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied.
The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes.
Methods: Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014.
Results: In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2-5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms.
The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02-1.05, P < 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03-2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19-0.42, P < 0.001) were independently associated with NDRD. Kaplan-Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P = 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality.
Conclusions: The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD.
These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.
CITA DEL ARTÍCULO Clin Kidney J. 2020 Jan 3;13(3):380-388. doi: 10.1093/ckj/sfz177. eCollection 2020 Jun