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. 2020 Jan 3;13(3):380-388.
doi: 10.1093/ckj/sfz177. eCollection 2020 Jun.

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
Affiliations

Risk factors for non-diabetic renal disease in diabetic patients

Sheila Bermejo et al. Clin Kidney J. .

Abstract

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.

Keywords: chronic kidney disease; diabetes mellitus; diabetic nephropathy; non-diabetic renal disease; renal biopsy.

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Figures

FIGURE 1
FIGURE 1
Diagnosis from renal biopsy: distribution of the number of patients according to their diagnosis in renal biopsy. GN, glomerulonephritis; FSGS, focal segmental glomerulosclerosis.
FIGURE 2
FIGURE 2
Renal and patient survival curves in all groups studied. Analysis using Kaplan–Meier of the different groups divided according to renal diagnoses: NDRD, DN and mixed forms (DN plus NDRD). (A) Renal replacement therapy (RRT). (B) Mortality. The need of RRT (log-rank test P < 0.001) and mortality (log-rank test P = 0.029) were significantly increased in biopsy-proven DN patients.
See this image and copyright information in PMC

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