Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – An Executive Summary

Liew, Adrian; Bavanandan, Sunita; Prasad, Narayan; Chang, Jer Ming; Eiam‐Ong, Somchai; Hao, Chuan‐Ming; Lim, Chiao Yuen; Lim, Soo Kun; Oh, Kook‐Hwan; Okada, Hirokazu; Susantitaphong, Paweena; Lydia, Aida; Tran, Hoanh; Villanueva, Russell; Yeo, See Cheng; Tang, Sydney C. W.

doi:10.1111/nep.13804

Cited by 14 publications

(13 citation statements)

References 2 publications

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“…We separated the biopsy details and clinical features at the presentation of the patients on the electronic records of the hospital information system of this public sector tertiary care institute. All patients had standard indications for biopsies, i.e., absence of retinopathy, presence of active sediments, red blood cells/cast in urine, heavy proteinuria on first presentation and sudden deterioration in degree of proteinuria, rapid decline in GFR as per standard guidelines [ 8 , 9 ]. Patients with Type-1 DM and pregnant and lactating females were excluded.…”

Section: Methodsmentioning

confidence: 99%

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy

Prasad

Veeranki

Bhadauria

et al. 2023

JCM

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Background and objectives: Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. Study design & setting: In this observational study, we prospectively collected the data of kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. Results: A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9 ± 11.5 years and 81% were males. The mean duration of DM was 6.4 ± 6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. Conclusions: The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM.

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Section: Methodsmentioning

confidence: 99%

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy

Prasad

Veeranki

Bhadauria

et al. 2023

JCM

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“…13,17 Because of the complex aetiology of renal disease in conjunction with type 2 diabetes, the broader term 'diabetes kidney disease' is now preferred. 18 In the Pasifika population, obesity-related focal segmental glomerulosclerosis is the commonest non-diabetic renal disease and like classical diabetic nephropathy, with which it can co-exist, it is characterised by macroalbuminuria, a bland urine sediment and progressive loss of renal function. In the population, we describe 29% of people with type 2 diabetes and macroalbuminuria had no retinopathy at the time the latter was recogniseda similar proportion to our findings in an earlier study.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice

Cooke

McCready²,

Doherty³

et al. 2021

J. Prim. Health Care

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INTRODUCTION: Macroalbuminuria in people with type 2 diabetes is common among Pasifika peoples and is associated with end-stage kidney disease and major cardiovascular disease.AIM: In a primary care practice catering for Pasifika people, to determine the time after first recognition of macroalbuminuria to the occurrence of major cardiovascular and renal events, and to examine the relationship with retinopathy status. METHODS:In a retrospective observational cohort study, we documented the occurrence of major cardiovascular events and amputations, end-stage kidney disease and death in 115 people with type 2 diabetes reviewed by a specialist diabetes physician at the Langimalie Tongan Health practice between 2005 and 2018. The follow up was 1-19 (median 9.5) years from the first recognition of macroalbuminuria (albumin:creatinine ratio of .30 g/mol). Survival was described by using Kaplan-Meier analysis.RESULTS: Macroalbuminuria was detected a mean of 9 years after the diagnosis of diabetes, at a mean age of 52 (standard deviation 12) years. Within 6 years of macroalbuminuria detection, 4% of people had died, 15% had reached end-stage kidney disease, 15% had cardiovascular events or amputations and 30% had the composite outcome of any of these. Within 12 years, the respective proportions were: 24%, 29%, 20% and 48%. The composite outcome was less frequent (P , 0.002) in patients without retinopathy at the time macroalbuminuria was recognised. Compared to patients with retinopathy, this group were younger (P ¼ 0.025), more obese (P , 0.0001), had better baseline renal function (P ¼ 0.018) and a shorter interval between the diagnosis of diabetes and recognition of macroalbuminuria (P , 0.0001). DISCUSSION:In this Pasifika population, macroalbuminuria was a marker for serious adverse cardiovascular and renal disease, and mortality, but in the 29% of patients without retinopathy at the time of recognition of macroalbuminuria, the natural history was more benign. The management of such comorbid patients is a substantial challenge for primary health-care services.

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“…Additionally, albumin is essential in plasma for maintaining the osmotic pressure of the blood [ 3 ]. Albumin levels are clinically useful in assessing liver function, kidney function, and nutritional status [ 4 ]. A retrospective study showed that hypoalbuminemia in patients with coronavirus disease 2019 was associated with illness progression to more severe stages and increased mortality [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Association between sleep duration and albumin in US adults: a cross-sectional study of NHANES 2015–2018

Guo

2022

BMC Public Health

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Background Albumin has multiple functions and is used in the clinical assessment of liver function, kidney function and nutritional status. However, few epidemiological studies have evaluated the association between sleep duration and albumin. Therefore, we carried out a cross-sectional study to address this issue. The aim of the study was to investigate the association between sleep duration and albumin in American adults based on the NHANES (National Health and Nutrition Examination Survey). Methods A total of 9,973 participants aged $$\ge$$ ≥ 20 years were included in this study from NHANES 2015–2018. Weighted data were calculated according to analytical guidelines. Linear regression models and smooth curve fitting were used to assess and describe the relationship between sleep duration and albumin. The inflection point was determined by a two-step recursive method. Moreover, univariate and stratified analyses were performed. Results There was an inverted U-shaped association between sleep duration and albumin levels. Albumin levels were highest when the sleep duration was 7.5 h. Compared to 7–8 h of sleep, short sleep duration was linked to lower albumin levels [sleep duration $$\le$$ ≤ 5 h: β $$=$$ = -1.00, 95% CI (-1.26, -0.74), P < 0.0001]. Compared to 7–8 h of sleep, long sleep duration was related to lower albumin levels [sleep duration $$>$$ > 9 h: β $$=$$ = -0.48, 95% CI (-0.68, -0.27), P < 0.0001]. Conclusions Sleep duration had an inverted U-shaped relationship with albumin, with short or long sleep duration associated with significantly lower albumin levels.

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Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – An Executive Summary

Cited by 14 publications

References 2 publications

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy

Morbidity and mortality after recognition of macroalbuminuria in Pasifika people with type 2 diabetes in a primary health-care practice

Association between sleep duration and albumin in US adults: a cross-sectional study of NHANES 2015–2018

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