Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy

Abstract

Background: Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). Methods: A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model. Results: In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ 2 = 26.534, p < 0.001) and cardiovascular (log-rank χ 2 = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332-1.842), eGFR (HR 0.943, 95% CI 0.919-0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132-1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487-1.821), HbA1C (HR 1.398, 95% CI 1.197-1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289-1.672) were associated with cardiovascular endpoints. Conclusion: Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.

Role of engulfment and cell motility 1 (ELMO1) gene polymorphism in development of diabetic kidney disease

“…Impaired lipoprotein lipase (LPL) activity triggers diabetic dyslipidemia; thus, during diabetes, dyslipidemia increases macrophage infiltration and excessive ECM formation in glomeruli, leading to the development of DKD [32]. Lipid profile was significantly higher in diabetic groups with no significant difference between group 1 and group 2; these results were confirmed by Wu et al and Wang et al [16,33]. However, AIP was significantly high in DKD patients.…”

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease

“…The selection of UACR and eGFR as indicators for the severity of DKD was due to their easy determination and universal access, in addition to being proven predictors of renal prognosis and not so much of cardiovascular prognosis, which seems more dependent on glycemic control and, therefore, appears to be less specific for renal involvement in diabetes 23 . In fact, eGFR and albuminuria have been shown to be independent predictors of renal outcomes in patients with DKD, whereas cardiovascular end-points are more dependent on age, HbA1c or phosphorus level 24 . The relevance of UACR and eGFR is confirmed in classic studies that identify them, together with pathological grade, as prognostic factors for the progression of DKD to end-stage renal disease 25 .…”

Severe 25-Hydroxyvitamin D Deficiency May Predict Poor Renal Outcomes in Patients With Biopsy-Proven Diabetic Nephropathy

“…All patients enrolled in this study had undergone ultrasound-guided percutaneous renal puncture when they were in the hospital, and the biopsy indications were as follows ( 19 , 20 ): 1) sudden onset of overt proteinuria; 2) the presence of glomerular hematuria; 3) a rapid decline in eGFR over a 3-month period; 4) no diabetic nephropathy; and 5) renal function decreasing rapidly with a short course of DM (<5 years). All biopsy specimens were cut into 3 μm sections, which were stained with Masson’s trichrome, periodic acid–Schiff and hematoxylin and eosin (H&E).…”