Renal outcomes and prognostic factors in patients with type-2 diabetes and chronic kidney disease confirmed by renal biopsy

Abstract

Aim: To evaluate the renal outcomes and prognostic factors among patients with type-2 diabetes (T2D) and biopsy-confirmed diabetic nephropathy (DN), non-diabetic renal disease (NDRD) and DN mixed with NDRD (MIX). Design and Methods: Patients with both T2D and chronic kidney disease (CKD) who underwent renal biopsy between January 2014 and December 2016 were recruited in this prospective observational study. Participants were divided into DN group, NDRD group, or MIX group according to the baseline pathological diagnosis. The primary endpoint was a composite renal event of end-stage renal disease (ESRD) or ⩾ 40% reduction in estimated glomerular filtration rate (eGFR). Results: Among the 292 participants included, 153 (52.4%) belonged to the DN group, 30 (10.3%) belonged to the NDRD group, and 109 (37.3%) belonged to the MIX group. During the median follow-up of 27 months, the adverse renal events occurred in 132 (44.2%) patients. Compared with NDRD group, the multiple adjusted hazard ratios (HRs) for renal events in patients with DN and MIX groups were 3.900 (95% confidence interval [CI]: 1.103–13.788) and 2.691 (95% CI: 0.662–10.936), respectively. Baseline lower eGFR (HR: 1.159, 95% CI: 1.060–1.266), severe proteinuria (HR: 2.047, 95% CI: 1.227–3.416), lower hemoglobin (HR: 1.170, 95% CI: 1.008–1.267), and a family history of diabetes (HR: 1.138, 95% CI: 1.008–2.285) were independent predictors for adverse renal outcomes in patients with DN. Conclusion: In patients with T2D and CKD, pure DN and MIX group displayed a worse renal prognosis than NDRD group. Worse renal function, severe proteinuria, lower hemoglobin, and a family history of diabetes may be associated with adverse renal outcomes in patients with DN.

A retrospective cohort study of clinical characteristics and outcomes of type 2 diabetic patients with kidney disease

“…Our understanding of the pathophysiologic mechanisms of T2DM with CKD has progressed as we continue to refine our classification of the pathologic types of T2DM with CKD. The commonly reported variables of NDKD, including DM shorter duration, lower glycosylated hemoglobin, absence of retinopathy, lower blood pressure, hematuria, higher proteinuria, higher hemoglobin, and lower serum creatinine were considered as the risk factors for kidney function progression in previous studies ( Horvatic et al, 2014 ; Jing et al, 2021 ; Prasad et al, 2023 ). To our knowledge, the etiology and demographic data is limited in South China, and there have been few studies comparing the prognosis of T2DM patients with CKD based on the classification of DN, NDKD, and DN + NDKD.…”

Correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 diabetic nephropathy

“…However, some studies suggest that 33–72.5% of patients with diabetes may have non-diabetic renal disease (NDRD), which can be influenced by the diabetic environment and require different treatment approaches [ 6 ]. Diabetic patients with DN have a worse prognosis than those with NDRD, so diagnosis of renal injuries may help stratify them, as accurate diagnosis and differentiation between DN and NDRD are crucial for effective clinical management [ 7 , 8 ]. Currently, clinicians rely on biomarkers, such as urinary albumin, estimated glomerular filtration rate (eGFR) and haemoglobin levels, as well as patient history and retinopathy status, to differentiate between the two conditions [ 9–11 ].…”