Dataset Information

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease.

ABSTRACT: Objective: This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). Method: This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our hospital were collected. Patients were allocated to two groups of rapid decliners and slow decliners according to the median eGFR slope. The associations between potential risk factors and rapid eGFR decline were analyzed using logistic regression. Results: A total of 128 eligible patients were enrolled and they had a mean age of 51.5 ± 10.7 years. During a median follow-up of 2 years, the median eGFR slope was -8.1 ± 14.4 mL/min/1.73 m2/year. The eGFR decline was significantly faster in patients with a family history of diabetes in first-degree relatives, nephrotic-range proteinuria, higher grades of glomerular pathology, and interstitial inflammation. No differences in the rate of the eGFR decline were observed in subgroups created according to sex, age, hypertension, glycosylated hemoglobin, diabetic retinopathy, interstitial fibrosis, and tubular atrophy. Logistic regression indicated that a family history of diabetes was independently associated with a rapid decline in eGFR, even after adjustment for factors including baseline eGFR and proteinuria. Conclusion: A family history of diabetes in first-degree relatives is independently associated with a rapid decline in eGFR in the current relatively young studied patients. Our findings suggested that early diagnosis and treatment is important for these patients.

SUBMITTER: Wang Y

PROVIDER: S-EPMC6923196 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease.

Wang Yiting Y Zhao Lijun L Zhang Junlin J Wu Yucheng Y Zhang Rui R Li Hanyu H Guo Ruikun R Han Qianqian Q Wang Tingli T Li Lin L Wang Shanshan S Liu Fang F

Frontiers in endocrinology 20191213

<b>Objective:</b> This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). <b>Method:</b> This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our ...[more]

PMID: 31920969

Similar Datasets

Project description:OBJECTIVE: We evaluated the structural-functional relationships and the prognostic factors for renal events, cardiovascular events, and all-cause mortality in type 2 diabetic patients with biopsy-proven diabetic nephropathy. RESEARCH DESIGN AND METHODS: Japanese type 2 diabetic patients with biopsy-proven diabetic nephropathy (n = 260) were enrolled. Patients were stratified by albuminuria (proteinuria) and estimated glomerular filtration rate (eGFR) at the time of renal biopsy. The outcomes were the first occurrence of renal events (requirement of dialysis or a 50% decline in eGFR from baseline), cardiovascular events (cardiovascular death, nonfatal myocardial infarction, coronary interventions, or nonfatal stroke), and all-cause mortality. RESULTS: The factors associated with albuminuria (proteinuria) regardless of eGFR were hematuria, diabetic retinopathy, low hemoglobin, and glomerular lesions. The factors associated with low eGFR regardless of albuminuria (proteinuria) were age and diffuse, nodular, tubulointerstitial, and vascular lesions. The glomerular, tubulointerstitial, and vascular lesions in patients with normoalbuminuria (normal proteinuria) and low eGFR were more advanced compared to those in patients with normoalbuminuria (normal proteinuria) and maintained eGFR. In addition, compared to patients with micro-/macroalbuminuria (mild/severe proteinuria) and low eGFR, their tubulointerstitial and vascular lesions were similar or more advanced in contrast to glomerular lesions. The mean follow-up period was 8.1 years. There were 118 renal events, 62 cardiovascular events, and 45 deaths. The pathological determinants were glomerular lesions, interstitial fibrosis and tubular atrophy (IFTA), and arteriosclerosis for renal events, arteriosclerosis for cardiovascular events, and IFTA for all-cause mortality. The major clinical determinant for renal events and all-cause mortality was macroalbuminuria (severe proteinuria). CONCLUSIONS: Our study suggests that the characteristic pathological lesions as well as macroalbuminuria (severe proteinuria) were closely related to the long-term outcomes of biopsy-proven diabetic nephropathy in type 2 diabetes.

Project description:BACKGROUND AND OBJECTIVES:Biomarkers may improve identification of individuals at risk of eGFR decline who may benefit from intervention or dialysis planning. However, available biomarkers remain incompletely validated for risk stratification and prediction modeling. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We examined serum cystatin C, urinary kidney injury molecule-1 (uKIM-1), and urinary neutrophil gelatinase-associated lipocalin (UNGAL) in 5367 individuals with type 2 diabetes mellitus and recent acute coronary syndromes enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial. Baseline concentrations and 6-month changes in biomarkers were also evaluated. Cox proportional regression was used to assess associations with a 50% decrease in eGFR, stage 5 CKD (eGFR<15 ml/min per 1.73 m2), or dialysis. RESULTS:eGFR decline occurred in 98 patients (1.8%) over a median of 1.5 years. All biomarkers individually were associated with higher risk of eGFR decline (P<0.001). However, when adjusting for baseline eGFR, proteinuria, and clinical factors, only baseline cystatin C (adjusted hazard ratio per 1 SD change, 1.66; 95% confidence interval, 1.41 to 1.96; P<0.001) and 6-month change in urinary neutrophil gelatinase-associated lipocalin (adjusted hazard ratio per 1 SD change, 1.07; 95% confidence interval, 1.02 to 1.12; P=0.004) independently associated with CKD progression. A base model for predicting kidney function decline with nine standard risk factors had strong discriminative ability (C-statistic 0.93). The addition of baseline cystatin C improved discrimination (C-statistic 0.94), but it failed to reclassify risk categories of individuals with and without eGFR decline. CONCLUSIONS:The addition of cystatin C or biomarkers of tubular injury did not meaningfully improve the prediction of eGFR decline beyond common clinical factors and routine laboratory data in a large cohort of patients with type 2 diabetes and recent acute coronary syndrome. PODCAST:This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_01_16_CJASNPodcast_18_3_G.mp3.

Dataset Information

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease.

Publications

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets