IDF21-0222 Prevalence and clinical predictors of Non-diabetic kidney disease in Type 2 Diabetes with renal involvement

Abstract

Background: Renal Involvement in individuals with Type-2 Diabetes (T2DM) may be due to diabetes per se i.e., Diabetes kidney disease (DKD) or to other cause other than T2DM i.e., non-Diabetic kidney disease (NDKD) and in a group of individuals may have both (DKD+NDKD). Differentiation between the same is only possible with renal biopsy. Specific treatment options are available for NDKD which could potentially change outcomes. Data regarding the proportion of subtypes of renal involvement in diabetes is limited and flawed due to biases in performing renal biopsy. Most previous studies of renal biopsies are retrospective in nature. With increasing burden of T2DM worldwide it is imperative that we to establish non-invasive markers which could help to identify those who might benefit from renal biopsy to establish diagnosis of NDKD. Aim: To determine proportion of patients with T2D with renal involvement who have DKD, NDKD or mixed disease. To identify possible clinical predictor/s which could help decision making for targeted renal biopsy to identify those with NDKD component (NDKD and mixed group). Method: We recruited consecutive patient with renal involvement (eGFR >30ml/min/m2 and/or urinary albumin: creatinine excretion >/=300mg/g. Clinical history, demography of patients, Lipid profile, Liver function test, electrolytes, serum creatinine, urea, Albumin, globulin, Uric acid, 24hr urinary protein (by autoanalyzer), Glycated hemoglobin (HbA1C) Complete blood count (CBC) (automated hematology analyzer), Urine RE/ME (dipstick method), retinopathy (Digital fundus camera) and neuropathy (VPT) were documented. Histopathological classification of renal biopsy sample was undertaken as per International Society of Nephrology and the Renal Pathology Society classification. Results: Total 110 were included of whom 31% were female. 73 patients (66.4%) had DKD 20 patients (18.2%) had NDKD and in 17 patients (15.4%) had an overlap (Mixed group). Amongst NDKD IgA nephropathy was commonest cause of NDKD (25%). Duration of diabetes (p<0.001), late age of onset (p=0.03), BMI (p=0.02), presence of hematuria (p=0.04), retinopathy (p=0.003) and neuropathy(p=0.002) were present in different proportions in the DKD vs the other two groups combined. Multivariable regression analysis however showed that only duration of diabetes was able to discriminate DKD from the other two groups. (AOR=0.9, CI 0.945 0.996, P=0.02), but it had sensitivity of 54% and specificity of 81% (AUC 0.765, P <0.001). Discussion: Almost 25% of our patients with T2DM had some evidence of NDKD (either pure NDKD or mixed) and warrants biopsy for appropriate diagnosis and management. Amongst currently used discriminators, only duration of diabetes was able to predict (not very robust) which patients needed biopsy to identify NDKD.