Changes in metabolic parameters and adverse kidney and cardiovascular events during glomerulonephritis and renal vasculitis treatment in patients with and without diabetes mellitus

Abstract

Background: Cardiovascular disease causes significant morbidity and mortality in patients with glomerulonephritis, which is increasingly diagnosed in older individuals who may have diabetes mellitus (DM). We evaluated the impact of DM on metabolic profile, renal and cardiovascular outcomes during treatment and follow-up of individuals with glomerulonephritis. Methods: We performed a retrospective cohort study of 601 consecutive adults with biopsy-proven glomerulonephritis for factors associated with kidney failure, hospitalization for cardiovascular events, and death. Biopsies with isolated diabetic nephropathy were excluded. Results: The median patient age was 49.8 years (36.7-60.9 years) with estimated glomerular filtration rate of 56.7 mL/min/1.73 m 2 (27.7-93.2 mL/min/1.73 m 2 ). DM was present in 25.4%. The most frequent diagnoses were minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) (29.5%), lupus nephritis (21.3%), immunoglobulin A (IgA) nephropathy (19.1%), and membranous nephropathy (12.1%). The median follow-up was 38.8 months (interquartile range [IQR], 26.8-55.8 months). Among 511 individuals with lupus nephritis, anti-neutrophil cytoplasmic antibody-associated vasculitis, MCD/FSGS, membranous nephropathy, and IgA nephropathy, 52 (10.2%) developed kidney failure at a median 16.4 months (IQR, 2.3-32.2 months), while 29 (5.7%) had cardiovascular-related hospitalizations at 12.9 months (IQR, 4.8-31.8 months) and 31 (6.1%) died at 13.5 months (IQR, 2.5-42.9 months) after diagnosis. Cox regression analysis found that baseline DM was independently associated with kidney failure (adjusted hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.06-4.05, p = 0.03) and cardiovascular-related hospitalization (adjusted HR, 2.69; 95% CI, 1.21-5.98, p = 0.02) but not with mortality. Conclusion: DM was strongly associated with kidney failure and hospitalization for cardiovascular events in patients with biopsy-proven glomerulonephritis.

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review

“…Glomerulonephritis due to systemic autoimmune conditions and primary glomerular diseases is associated with an increased risk of cardiovascular disease (CVD) and CVD-related hospitalizations and death [1][2][3]. The risk of CVD in glomerulonephritis due to IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, and minimal change disease was more than double (standardized incidence ratio: 2.46, 95% confidence interval: 2.12-2.82) that of the general population [2].…”

Impact of Diabetic Lesions on Pathology, Treatment, and Outcomes of Glomerular Diseases

“…6,7 People with diabetes are frequently excluded from clinical trials and observational cohort studies focused on GD. [8][9][10][11] Diabetes is a systemic illness which can affect immunologic and inflammatory modulators, 12 thus affecting potential for response to treatments, infectious [13][14][15] and cardiovascular complications, 16,17 and progression of kidney disease. 16,18 Moreover, several lesions are shared between DGS and other GDs (e.g., mesangial matrix expansion, podocyte activation and effacement, focal glomerulosclerosis, and tubulointerstitial and vascular lesions), potentially complicating etiologic interpretation of these lesions and clinical decisions regarding immunosuppression.…”

Cardiovascular risk assessment in lupus nephritis and ANCA-associated vasculitis in real-world nephrology practice

“…Observational studies have found that anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is associated with increased risks of stroke {sub-distribution hazard ratio 1.49 [95% confidence interval (CI) 1.10–2.02]} [ 1 ], cardiovascular (CV) events [relative risk (RR) 1.65 (95% CI 1.23–2.22)] and ischemic heart disease [RR 1.60 (95% CI 1.39–1.84)] [ 2 ], while systemic lupus erythemathosus had greater odds of atherosclerotic CV disease [adjusted odds ratio (OR) 1.46 (95% CI 1.41–1.51)] [ 3 ]. Similarly, lupus nephritis and ANCA-associated vasculitis increased the risks of CV-related hospitalization and death among multiethnic Southeast Asians with glomerulonephritis [ 4 ]. It is thus timely that the European League Against Rheumatism (EULAR) multidisciplinary task force published recommendations for CV risk prediction and management in lupus and vasculitis, highlighting the need for clinicians to be aware of the increased CV risk and screen for risk factors within 6 months of diagnosis [ 5 ].…”

“…lupus nephritis and renal vasculitis, proactively screen and manage CV risks; even among the general population with early chronic kidney disease, pooled estimates of hazard ratios for CV disease and mortality ranged from 1.5 to 4.9 compared with normal renal function [ 6 ]. Thus 146 adults with lupus nephritis and ANCA-associated vasculitis were identified from our single-center electronic medical records review [ 4 ] to evaluate the prevalence of CV risk assessment during routine nephrology clinical practice. Traditional CV risk factors such as comorbidity, blood pressure, kidney function and proteinuria were readily available for all patients.…”