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Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience

Clinical and Experimental Nephrology volume 21, pages 307–315 (2017)Cite this article

Abstract

Background

Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD.

Method

A total of 447 diabetic patients with advanced CKD, age of 18–80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score.

Results

Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction.

Conclusions

Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system.

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Acknowledgments

This work was supported by grants from the Taiwan Ministry of Science and Technology (MOST-104-2314-B-002-126-MY3) and the National Taiwan University Hospital (NTUH-104-S2810 and NTUH 105-A-123).

Author information

Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan

    Ping-Min Chen & Chih-Kang Chiang

  2. Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA

    Ping-Min Chen

  3. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan

    Takashi Wada

  4. Department of Laboratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan

    Takashi Wada

  5. Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan

    Chih-Kang Chiang

  6. Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    Chih-Kang Chiang

Authors
  1. Ping-Min Chen
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  2. Takashi Wada
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  3. Chih-Kang Chiang
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Corresponding author

Correspondence to Chih-Kang Chiang.

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Cite this article

Chen, PM., Wada, T. & Chiang, CK. Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience. Clin Exp Nephrol 21, 307–315 (2017). https://doi.org/10.1007/s10157-016-1290-8

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Keywords

  • Chronic kidney disease
  • Diabetes mellitus
  • Proteinuria