A diagnostic criterion for the dynamics of chronic kidney disease in patients with diabetes

Abstract

Aim to develop and clinically substantiate an objective quantitative diagnostic criterion for the dynamics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM).
 Material and methods. A comparative cross-observational study of clinical indicators was performed in a general sample of patients with type 2 diabetes, divided into groups according to the parameter "GFR reduction index (RI_GFR)", which characterizes the dynamics of CKD and the development of cardiorenal syndrome in patients with diabetes. 150 protocols of outpatient consultations were selected using the compliance criteria, including the data on 72 clinical indices. The threshold value for dividing the groups of "slow" and "fast" progression of CKD according to the RI_GFR parameter was 4.21 ml/min/1.73 m2. By the method of correlation analysis, the strength of the interrelations of clinical indicators was determined, the Student's t-test and one-factor analysis of variance were used to compare the mean values of independent variables.
 Results. To quantify the dynamics of the progression of CKD in DM patients, a diagnostic parameter RI_GFR was proposed, calculated according to the original formula based on the value of GFR and the duration of the disease of DM. When assessing the statistical relationships between RI_GFR and clinical indicators, the significance of correlations with creatinine levels, duration of diabetes, insulin therapy, age, history of acute myocardial infarction, dosage of sulfonylureas, as well as the absence of correlation with indicators of achievement of glycemic control goals was noted. When dividing the sample into groups according to the rate of progression of CKD, significant differences were found in the parameters of the duration of DM disease and the use of insulin therapy, the total dose of insulin, the level of glycemia, and body mass index. Insufficient level of reliability was found in the parameters of the dosage of sulfonylureas and age.
 Conclusion. The developed original diagnostic parameter RI_GFR allows us to give an objective characteristic of the dynamics of CKD in patients with DM. A statistically significant correlation was found between the rate of progression of diabetic kidney damage and cardiovascular risk factors with less influence of the glycemic control factor at the stage of formation of cardiorenal syndrome. To clarify the influence of hemodynamic and glycemic factors on the development of cardiorenal syndrome, it is necessary to continue the study using the logistic regression analysis.