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Phenotyping normal kidney function in elderly patients with type 2 diabetes: a cross-sectional multicentre study

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Abstract

Aims

Type 2 diabetes (T2D) accelerates the decline in glomerular function; however, some individuals do not develop chronic kidney disease despite advanced age and long-lasting T2D. We aimed to phenotype patients with T2D aged 80 years or older who presented with a fully preserved kidney function.

Methods

From an Italian population of 281,217 T2D outpatients, we collected data on demographics, anthropometrics, diabetes duration, HbA1c, fasting plasma glucose, lipids, liver enzymes, estimated glomerular filtration rate (eGFR), albumin excretion rate (AER), chronic complications, and medication use. We primarily compared patients with a fully preserved kidney function (eGFR > 90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G1A1) with those with mild kidney impairment (eGFR 60–90 ml/min/1.73 m2 and AER < 30 mg/24 h, or G2A1).

Results

N = 113,860 had available data for eGFR and AER, 21,648 of whom were aged ≥ 80. G1A1 (n = 278) and G2A1 (n = 6647) patients represented 1.3 and 30.7% of aged T2D patients, respectively, with an average diabetes duration of 16 years. Differences between the G1A1 and G2A1 groups were entered in a multiple logistic regression analysis with and without imputation of missing data. After adjustment and in both imputed and non-imputed datasets, younger age, lower BMI and lower triglycerides were associated with fully preserved versus mildly impaired kidney function. The comparison between G1A1 and G1A2/3 yielded different results.

Conclusions

In a rare population of patients with a fully preserved kidney function despite old age and long-lasting diabetes, lower BMI and triglycerides suggest that protection from lipotoxicity may preserve kidney function over time.

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Acknowledgements

We wish to thank Alessia Russo, Italian Diabetes Society, for the invaluable technical support.

Agostino Consoli and Gloria Formoso (Dipartimento di Medicina e Scienze dell’Invecchiamento—Università Degli studi G. D’Annunzio di Chieti-Pescara); Giovanni Grossi (Ospedale San Francesco di Paola—Azienda Sanitaria Provinciale di Cosenza); Achiropita Pucci (Azienda Sanitaria Provinciale di Cosenza); Giorgio Sesti and Francesco Andreozzi (Azienda Ospedaliero Universitaria di Catanzaro); Giuseppe Capobianco (Azienda Sanitaria Locale Napoli 2 Nord); Adriano Gatti (Ospedale San Gennaro dei Poveri—Azienda Sanitaria Locale Napoli 1 Centro); Riccardo Bonadonna, Ivana Zavaroni and Alessandra Dei Cas (Azienda Ospedaliero Universitaria di Parma); Giuseppe Felace (Ospedale di Spilimbergo—Azienda per l’Assistenza Sanitaria n.5 Friuli Occidentale); Patrizia Li Volsi (Ospedale di Pordenone—Azienda per l’Assistenza Sanitaria n.5 Friuli Occidentale); Raffaella Buzzetti and Gaetano Leto (Ospedale Santa Maria Goretti—Azienda Sanitaria Locale di Latina); Gian Pio Sorice (Fondazione Policlinico Universitario A. Gemelli, Roma); Paola D’Angelo (Ospedale Sandro Pertini—Azienda Sanitaria Locale Roma 2); Susanna Morano (Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma); Antonio Carlo Bossi (Ospedale di Treviglio—Azienda Socio Sanitaria Territoriale Bergamo Ovest); Edoardo Duratorre (Ospedale Luini Confalonieri di Luino—Azienda Socio Sanitaria Territoriale Sette Laghi); Ivano Franzetti (Ospedale Sant’Antonio Abate di Gallarate—Azienda Socio Sanitaria Territoriale Valle Olona); Paola Silvia Morpurgo (Ospedale Fatebenefratelli—Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco); Emanuela Orsi (Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico di Milano); Fabrizio Querci (Ospedale Pesenti Fenaroli di Alzano Lombardo—Azienda Socio Sanitaria Territoriale Bergamo Est); Massimo Boemi† and Federica D’Angelo (Presidio Ospedaliero di Ricerca INRCA-IRCCS di Ancona); Massimiliano Petrelli (Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona); Gianluca Aimaretti and Ioannis Karamouzis (Azienda Ospedaliero Universitaria Maggiore della Carità di Novara); Franco Cavalot (Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano); Giuseppe Saglietti† (Ospedale Madonna del Popolo di Omegna—Azienda Sanitaria Locale Verbano Cusio Ossola); Giuliana Cazzetta (Casa della Salute, Ugento—Distretto Socio Sanitario Gagliano del Capo—Azienda Sanitaria Locale di Lecce); Silvestre Cervone (Presidio ospedaliero San Marco in Lamis—Distretto Socio Sanitario San Marco in Lamis—Azienda Sanitaria Locale di Foggia); Eleonora Devangelio (Distretto Socio Sanitario di Massafra—Azienda Sanitaria Locale di Taranto); Olga Lamacchia (Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia); Salvatore Arena (Ospedale Umberto I—Azienda Sanitaria Provinciale di Siracusa); Antonino Di Benedetto (Azienda Ospedaliera Universitaria Policlinico G. Martino di Messina); Lucia Frittitta (Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi di Catania); Carla Giordano (Azienda Universitaria Policlinico Paolo Giaccone di Palermo); Salvatore Piro (Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi di Catania); Manfredi Rizzo, Roberta Chianetta and Carlo Mannina (Azienda Universitaria Policlinico Paolo Giaccone di Palermo); Roberto Anichini (Ospedale San Jacopo di Pistoia—Azienda USL Toscana Centro); Giuseppe Penno (Azienda Ospedaliero Universitaria Pisana); Anna Solini (Azienda Ospedaliera Universitaria Pisana); Bruno Fattor (Comprensorio Sanitario di Bolzano—Azienda Sanitaria della Provincia Autonoma di Bolzano); Enzo Bonora and Massimo Cigolini (Azienda Ospedaliero Universitaria Integrata di Verona); Annunziata Lapolla and Nino Cristiano Chilelli (Complesso Socio Sanitario Ai Colli—Azienda ULSS n.6 Euganea); Maurizio Poli (Ospedale Girolamo Fracastoro di San Bonifacio—Azienda ULSS n.9 Scaligera); Natalino Simioni and Vera Frison (Ospedale di Cittadella—Azienda ULSS n.6 Euganea); Carmela Vinci (Azienda ULSS n.4 Veneto Orientale).

Funding

The study was supported by the Italian Diabetes Society.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    G P Fadini, G Zatti & A Avogaro

  2. Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy

    A Solini

  3. Department of Mathematics, University of Pisa, Pisa, Italy

    M L Manca

  4. Ospedale Maggiore di Novara, 28100, Novara, Italy

    I Karamouzis

  5. Department of Clinical and Experimental Medicine, University of Messina, 98122, Messina, Italy

    A Di Benedetto

  6. Department of Internal and Special Medicine, University of Catania, 95122, Catania, Italy

    L Frittitta

Authors
  1. G P Fadini
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  2. A Solini
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  3. M L Manca
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  4. G Zatti
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  5. I Karamouzis
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  6. A Di Benedetto
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  7. L Frittitta
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  8. A Avogaro
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Consortia

For the DARWIN-T2D Network

  • Agostino Consoli
  • , Gloria Formoso
  • , Giovanni Grossi
  • , Achiropita Pucci
  • , Giorgio Sesti
  • , Francesco Andreozzi
  • , Giuseppe Capobianco
  • , Adriano Gatti
  • , Riccardo Bonadonna
  • , Ivana Zavaroni
  • , Alessandra Dei Cas
  • , Giuseppe Felace
  • , Patrizia Li Volsi
  • , Raffaella Buzzetti
  • , Gaetano Leto
  • , Gian Pio Sorice
  • , Paola D’Angelo
  • , Susanna Morano
  • , Antonio Carlo Bossi
  • , Edoardo Duratorre
  • , Ivano Franzetti
  • , Paola Silvia Morpurgo
  • , Emanuela Orsi
  • , Fabrizio Querci
  • , Massimo Boemi
  • , Federica D’Angelo
  • , Massimiliano Petrelli
  • , Gianluca Aimaretti
  • , Ioannis Karamouzis
  • , Franco Cavalot
  • , Giuseppe Saglietti
  • , Giuliana Cazzetta
  • , Silvestre Cervone
  • , Eleonora Devangelio
  • , Olga Lamacchia
  • , Salvatore Arena
  • , Antonino Di Benedetto
  • , Lucia Frittitta
  • , Carla Giordano
  • , Salvatore Piro
  • , Manfredi Rizzo
  • , Roberta Chianetta
  • , Carlo Mannina
  • , Roberto Anichini
  • , Giuseppe Penno
  • , Anna Solini
  • , Bruno Fattor
  • , Enzo Bonora
  • , Massimo Cigolini
  • , Annunziata Lapolla
  • , Nino Cristiano Chilelli
  • , Maurizio Poli
  • , Natalino Simioni
  • , Vera Frison
  •  & Carmela Vinci

Contributions

Study design: GPF and AS. Data collection and analysis: GPF, AS, AA, GZ, MLM, IK, LF, ADB. Manuscript writing GPF, AS, AA. Manuscript revision GZ, MLM, LF, ADB, IK. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to G P Fadini.

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Conflict of interest

GPF received Grant support, lecture or advisory board fees from AstraZeneca, Boehringer-Ingelheim, Eli Lilly, NovoNordisk, Sanofi, Genzyme, Abbott, Novartis, Merck Sharp and Dohme. AS received research Grants from Astra Zeneca and served as advisory board member for Boehringer-Ingelheim and Eli-Lilly. ADB received research grants from NovoNordisk and AstraZeneca, and lecture fees from Boehringer-Ingelheim, Eli-Lilly, Sanofi, Lifescan, Menarini diagnostics. LF received research grant from Therascience, lecture or advisory board fees from Eli-Lilly, Novo-Nordisk, Takeda, AstraZeneca. AA received research grants, lecture or advisory board fees from Merck Sharp and Dome, AstraZeneca, Novartis, Boeringher-Ingelheim, Sanofi, Mediolanum, Janssen, NovoNordisk. GZ, MLM and IK declare no conflict of interest.

Ethical standard

The study was approved by ethical committees of participanting Centers and it was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki.

Informed consent

In agreement with National regulations on data protection and privacy, no informed consent was collected because the database was anonymous.

Additional information

Managed by Massimo Porta.

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Fadini, G.P., Solini, A., Manca, M.L. et al. Phenotyping normal kidney function in elderly patients with type 2 diabetes: a cross-sectional multicentre study. Acta Diabetol 55, 1121–1129 (2018). https://doi.org/10.1007/s00592-018-1194-z

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  • DOI: https://doi.org/10.1007/s00592-018-1194-z

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