Abstract
Diabetes duration, diabetic retinopathy (DR), and a diagnostic model have been proposed as clinical parameters favoring the presence of diabetic nephropathy (DN) in biopsied patients with diabetic kidney disease. DN, compared with non-diabetic renal disease, had poorer renal outcomes. We tested whether these clinical parameters favoring DN are associated with poorer renal outcomes in non-biopsied patients. In this study, 1330 patients with type 2 diabetes and chronic kidney disease stages 1–4 were included and divided according to diabetes mellitus (DM) duration >8 years, DR, or a diagnostic model for DN. These clinical parameters favoring DN were found in 62–77% of patients and associated with higher levels of proteinuria. In a Cox survival analysis, DR and the diagnostic model favoring DN were associated with an increased risk for end-stage renal disease with adjusted hazard ratios of 1.69 (95% CI: 1.16–2.45, P = 0.006) and 1.66 (95% CI: 1.05–2.61, P = 0.029), respectively. DR was associated with an increased risk for rapid renal disease progression. DM >8 years was not associated with renal outcome. Propensity score-matched analyses also showed similar results. In conclusion, DR and the diagnostic model favoring DN were associated with poorer renal outcomes.
Highlights
Clinical differentiation between diabetic nephropathy (DN) and NDRD is difficult
We found that diabetic retinopathy (DR), absence of hematuria, low estimated glomerular filtration rate (eGFR), and high HbA1c were associated with DN (Supplemental Table 1)
Our study investigated whether diabetes mellitus (DM) > 8 years, DR, and the diagnostic model favoring DN are associated with clinical outcomes in patients with diabetic kidney disease
Summary
Clinical differentiation between DN and NDRD is difficult. Several parameters, especially longer diabetes duration, diabetic retinopathy (DR), and absence of hematuria have been proposed as predictors for DN in recent meta-analyses[9, 10]. A diagnostic model developed at a single center in China which included diabetes duration, systolic blood pressure, HbA1c, hematuria, hemoglobin and diabetic retinopathy as parameters, showed a PPV of 0.89 for DN11. These biopsy studies included specially selected patients with DKD, who usually presented with heavy proteinuria and were young[9, 10, 12]. We hypothesized that longer diabetes duration, DR and the diagnostic model favoring DN are associated with less favorable renal outcomes, cardiovascular events and all-cause mortality in non-biopsied patients with DKD
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