Abstract
BackgroundIdentifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN) share common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in patients with Type 2 diabetes.MethodsA prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded. Foot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular filtration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine ratio (ACR) >3.4 mg/mmol.ResultsTwo hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred and ninety patients (83.4%) had eGFR ≥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity (i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of albuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity, diabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular disease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = −3.551, p = 0.036).ConclusionsPatients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these patients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of CKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic performance of our findings in predicting CKD development, and to compare the performance of the monofilament test with albuminuria.
Highlights
Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD)
In longitudinal studies of patients with type 2 diabetes, we have previously identified obstructive sleep apnoea (OSA) and cardiac autonomic neuropathy (CAN) as novel predictors of estimated glomerular filtration rate (eGFR) decline [7, 8]
Evident DPN is common in patients with CAN and in patients with OSA [9, 10] and as diabetic peripheral neuropathy (DPN) shares many aspects of its pathogenesis with CKD, we hypothesised that foot insensitivity may predict changes in renal function in patients with Type 2 diabetes
Summary
Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to prevent/slow the progression to end-stage renal disease (ESRD). Chronic kidney disease (CKD) in diabetes is the most common cause of end-stage renal disease (ESRD) and is associated with high morbidity and mortality [1, 2]. Albuminuria is widely used to predict progression to ESRD but eGFR decline may be the only manifestation of CKD progression in patients with diabetes without any evidence of albuminuria in up to 30% of cases [5, 6]. Evident DPN is common in patients with CAN and in patients with OSA [9, 10] and as diabetic peripheral neuropathy (DPN) shares many aspects of its pathogenesis with CKD, we hypothesised that foot insensitivity may predict changes in renal function in patients with Type 2 diabetes
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