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Identification of clinical predictors of diabetic nephropathy and non-diabetic renal disease in Chinese patients with type 2 diabetes, with reference to disease course and outcome

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Abstract

Aims

To determine the prevalence of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus (T2DM), and the important clinical predictors of renal outcome and clinical course.

Methods

We conducted a retrospective analysis of clinical, laboratory, and histopathologic data from T2DM patients with renal involvement confirmed by renal biopsy (n = 505). The outcome was defined as the progression to end-stage renal disease (ESRD).

Results

Renal biopsy revealed that 302 patients (59.8%) had DN, 174 (34.5%) had NDRD, and 29 (5.7%) had NDRD superimposed on DN. In multivariate analysis, the absence of diabetic retinopathy (DR) (odds ratio (OR) 4.171, 95% confidence interval (CI) 1.810–9.612; P = 0.001), absence of hypertension (OR 2.412, 95% CI 1.095–5.315; P = 0.029), shorter duration of diabetes (OR 1.015, 95% CI 1.008–1.022; P < 0.001), lower-risk chronic kidney disease (CKD) heat map category (green, yellow and orange) (OR 3.885, 95% CI 1.289–11.707; P = 0.016) and lower glycated hemoglobin (HbA1c) (OR 1.339, 95% CI 1.114–1.610; P = 0.002) were significant clinical predictors of NDRD. Patients with DN had a poorer 5-year renal outcome than those with NDRD, and multivariate analysis identified DN as an independent risk factor for progression to ESRD, when adjusted for important clinical variables (P < 0.05).

Conclusions

This study has identified the absence of DR and hypertension, lower-risk CKD heat map category, shorter duration of diabetes, and lower HbA1c as useful clinical predictors of NDRD. Renal biopsy is recommended for patients with T2DM and renal disease to obtain an accurate diagnosis and determine timely disease-specific treatment, which should increase the chance of a good renal outcome.

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Acknowledgements

This study was supported by two projects, which are the project of National Natural Science Foundation of China (81670662) and the applied foundational research of the Science and Technology Department in Sichuan province (2018JY0411).

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Author notes

  1. Jiali Wang and Qianqian Han contributed equally to the work and both are first authors.

Authors and Affiliations

  1. Division of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Jiali Wang, Qianqian Han, Lijun Zhao, Junlin Zhang, Yiting Wang, Yucheng Wu, Tingli Wang, Rui Zhang, Premesh Grung & Fang Liu

  2. Division of Nephrology, Mianyang Central Hospital, Mianyang, 621000, China

    Jiali Wang

  3. Division of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China

    Huan Xu

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  1. Jiali Wang
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Correspondence to Fang Liu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (West China Hospital of Sichuan University Biomedical Research Ethics Committee, 2013R01) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wang, J., Han, Q., Zhao, L. et al. Identification of clinical predictors of diabetic nephropathy and non-diabetic renal disease in Chinese patients with type 2 diabetes, with reference to disease course and outcome. Acta Diabetol 56, 939–946 (2019). https://doi.org/10.1007/s00592-019-01324-7

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  • DOI: https://doi.org/10.1007/s00592-019-01324-7

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