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Title: Risk factors for non-diabetic renal disease in diabetic patients
Author: Bermejo, Sheila
Gonzalez, Ester
López Revuelta, Katia
Ibernon, Meritxell
López, Diana
Martín Gómez, Adoración
García Osuna, Rosa
Linares, Tania
Díaz, Montserrat
Martín, Nàdia
Barros Freiría, Xoana
Marco, Helena
Navarro, Maruja Isabel
Esparza, Noemí
Elias, Sandra
Coloma, Ana
Robles, Nicolás Roberto
Agraz, Irene
Poch, Esteban
Rodas, Lida
Lozano, Víctor
Fernández, Beatriz
Hernandez, Eduardo
Martinez, Maria Isabel
Stanescu, Ramona Ionela
Moirón, José Pelayo
García, Núria
Goicoechea, Marian
Calero, Francesca
Bonet, Josep
Galceran, Josep M.
Liaño, Fernando
Pascual, Julio
Praga, Manuel
Fulladosa, Xavier
Soler, María José
Keywords: Diabetis
Insuficiència renal crònica
Chronic renal failure
Issue Date: 1-Jun-2020
Publisher: Oxford University Press
Abstract: Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7612.8 years, creatinine was 2.862.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2-5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02-1.05, P< 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03-2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19-0.42, P< 0.001) were independently associated with NDRD. Kaplan-Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P< 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P< 0.001), higher serum creatinine (P< 0.001), higher proteinuria (P< 0.001), DR (P = 0.007) and DN (P< 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P< 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.
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It is part of: Clinical Kidney Journal, 2020, vol. 13, num. 3, p. 380-388
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Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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