Acute Kidney Injury and Progressive Diabetic Kidney Disease: An Epidemiological Perspective

Abstract

Purpose: Diabetic kidney disease (DKD) represents a unique subset of patients with chronic kidney disease (CKD). Acute kidney injury (AKI) is implicated in DKD progression; however, their interplay is not studied well. We studied risk factors for AKI and the effect of AKI on disease progression in a homogeneous group of patients with DKD. Patients and Methods: We conducted a retrospective open cohort study of patients with DKD at a single tertiary care centre between August 2016-August 2019. Patients with a minimum follow-up of 2 years were included in the study. The incidence, etiology and risk factors for AKI were studied. The primary outcome studied was the effect of AKI on reduction in estimated glomerular filtration rate (eGFR) in DKD. Loss in eGFR by 50% and need for renal replacement therapy or reaching CKD stage V were studied as secondary outcomes. Results: Two hundred and ninety-two DKD patients meeting the study criteria with a follow-up of 29.57 (±4.3) months were included. The incidence of AKI was 31.1%. Sepsis was the most common etiology (61%). Proteinuria was an independent risk factor for AKI after adjusting for covariates (adjusted OR-1.158; 95% CI (1.018-1.316); p=0.025). In patients with AKI, median decline in eGFR was 10.29 mL/min/1.73m 2 /year (IQR-5.58-13.84) which was significantly higher compared to patients with no AKI [eGFR 7.25 (IQR 5.06-11.38); p-0.014]. On subgroup analysis, sepsis-induced AKI (versus non-sepsis AKI; p<0.001) and higher AKI stage (stage 2/3 versus stage 1; p=0.019) were associated with a faster decline in eGFR. Conclusion: AKI is common in patients with DKD with sepsis being the most common etiology. AKI in diabetic kidney disease is associated with a faster decline in eGFR. Baseline proteinuria is an independent risk factor for AKI.

Update on the Mechanisms of Tubular Cell Injury in Diabetic Kidney Disease

“…Patients with DKD were susceptible to severe AKI and usually had a worse prognosis following AKI (163). Advani recently summarized clearly that diabetes may increase the risk of AKI while AKI may increase the risk of CKD in diabetes (164).…”

Is there a relationship between the prevalence of autoimmune thyroid disease and diabetic kidney disease?

“…Diabetic kidney disease (DKD) is one of the major chronic complications in diabetes mellitus type 1 (DM1) and 2 and is currently the most common cause of the end-stage renal disease (ESRD). DM contributes to approximately 40% of the newly diagnosed ESRD cases in patients each year [ 4 , 5 ]. The pathogenesis of DKD is multifactorial.…”

Acute kidney injury in diabetic patients: A narrative review

“…According to Prabhu et al [22] , there was a correlation between AKI incidence and lower baseline eGFR, and higher proteinuria. With every 1 g rise in proteinuria, they have revealed that AKI risk was increased by 15.8%.…”

“…Along with dysfunctional immune systems both humoral and cell-mediated, increase neutrophil dysfunction also contributes to an increased risk of sepsis. [22] Sepsis was the primary cause of AKI in a retrospective study done by Prabhu et al [22] In addition, they showed that there was a higher eGFR decline secondary to sepsis-related AKI as compared to other etiologies. Diabetes mellitus has been demonstrated to be an independent risk factor in a recent meta-analysis of sepsis-related AKI.…”