Risk factors for non-diabetic renal disease in diabetic patients
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- dc.contributor.author Bermejo García, Sheila
- dc.contributor.author Pascual Santos, Julio
- dc.contributor.author Soler, María José
- dc.date.accessioned 2021-06-15T06:53:44Z
- dc.date.available 2021-06-15T06:53:44Z
- dc.date.issued 2020
- dc.description.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 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 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.
- dc.format.mimetype application/pdf
- dc.identifier.citation Bermejo S, González E, López-Revuelta K, Ibernon M, López D, Martín-Gómez A, et al. Risk factors for non-diabetic renal disease in diabetic patients. Clin Kidney J. 2020 Jan 3; 13(3): 380-388. DOI: 10.1093/ckj/sfz177
- dc.identifier.doi http://dx.doi.org/10.1093/ckj/sfz177
- dc.identifier.issn 2048-8505
- dc.identifier.uri http://hdl.handle.net/10230/47876
- dc.language.iso eng
- dc.publisher Oxford University Press
- dc.rights Copyright © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
- dc.subject.keyword Chronic kidney disease
- dc.subject.keyword Diabetes mellitus
- dc.subject.keyword Diabetic nephropathy
- dc.subject.keyword Non-diabetic renal disease
- dc.subject.keyword Renal biopsy
- dc.title Risk factors for non-diabetic renal disease in diabetic patients
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion