Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes

BACKGROUND: A growing body of evidence demonstrates increasing prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in subjects with type 2 diabetes (T2D), while proportion of albuminuric pattern is decreasing. AIMS: To determine the clinical and laboratory parameters associated with diff...

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Autores principales:	Vadim V. Klimontov, Anton I. Korbut, Olga N. Fazullina, Ilya V. Vinogradov, Vyacheslav V. Romanov
Formato:	article
Lenguaje:	EN RU
Publicado:	Endocrinology Research Centre 2019
Materias:	diabetes chronic kidney disease podocytes albuminuria glomerular filtration rate Nutritional diseases. Deficiency diseases RC620-627
Acceso en línea:	https://doaj.org/article/61d9f3457c714d6182d2aed91caa542f
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spelling	oai:doaj.org-article:61d9f3457c714d6182d2aed91caa542f2021-11-14T09:00:22ZClinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes2072-03512072-037810.14341/DM10277https://doaj.org/article/61d9f3457c714d6182d2aed91caa542f2019-12-01T00:00:00Zhttps://www.dia-endojournals.ru/jour/article/view/10277https://doaj.org/toc/2072-0351https://doaj.org/toc/2072-0378BACKGROUND: A growing body of evidence demonstrates increasing prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in subjects with type 2 diabetes (T2D), while proportion of albuminuric pattern is decreasing. AIMS: To determine the clinical and laboratory parameters associated with different patterns of CKD in patients with T2D. METHODS: This observational, single-center, cross-sectional study included 360 patients with T2D duration ≥10 years. Patients with urinary albumin/creatinine ratio (UACR) <3 mg/mmol and estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2 were classified as no-CKD group (n=89). Patients with UACR <3 mg/mmol and eGFR <60 ml/min/1.73 m2 formed NA-CKD group (n=111). Individuals with eGFR ≥60 ml/min/1.73 m2 and UACR mg/mmol ≥3 were recorded as albuminuric with preserved renal function (A-CKD–, n=87). Patients with eGFR <60 ml/min/1.73 m2 and UACR mg/mmol ≥3 mg/mmol were considered as albuminuric CKD group (A-CKD+, n=73). Urinary nephrin and podocin, the podocyte injury markers, and whey acidic protein four-disulfide core domain protein 2 (WFDC-2), a marker of tubulointerstitial involvement, was assessed by ELISA and compared to control (20 non-diabetic subjects). RESULTS: Age ≥65 years (p=0.0001), duration of T2D ≥15 years (p=0.0009), female sex (p=0.04), and therapy with diuretics (p=0.0005) were found as risk factors for NA-CKD. The risk factors for A-CKD were male sex (p=0.01), smoking (p=0.01), waist-to-hip ratio >1 (p=0.01) and HbA1c levels >8% (p=0.005). The duration of T2D ≥15 years (p=0.01) and the use of dihydropyridine calcium channel blockers (p=0.01) were associated with A-CKD+. In T2D groups, the urinary excretion of nephrin and podocin was increased (all p<0.001), more markedly in albuminuric individuals (p<0.01 vs. NA-CKD). WFDC-2 excretion was increased in men from all diabetic groups (p<0.05) and in women with decreased eGFR only (p<0.05 vs. the control and NA-CKD). CONCLUSIONS: The CKD patterns in T2D are heterogeneous according to their clinical and laboratory characteristics. The changes in the excretion of nephrin and podocin indicate the association of albuminuric patterns with podocyte injury. A decrease in eGFR in women with T2D is associated with an increase in urinary excretion of WFDC-2, tubulointerstitial fibrosis marker.Vadim V. KlimontovAnton I. KorbutOlga N. FazullinaIlya V. VinogradovVyacheslav V. RomanovEndocrinology Research Centrearticlediabeteschronic kidney diseasepodocytesalbuminuriaglomerular filtration rateNutritional diseases. Deficiency diseasesRC620-627ENRUСахарный диабет, Vol 22, Iss 6, Pp 515-525 (2019)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	diabetes chronic kidney disease podocytes albuminuria glomerular filtration rate Nutritional diseases. Deficiency diseases RC620-627
spellingShingle	diabetes chronic kidney disease podocytes albuminuria glomerular filtration rate Nutritional diseases. Deficiency diseases RC620-627 Vadim V. Klimontov Anton I. Korbut Olga N. Fazullina Ilya V. Vinogradov Vyacheslav V. Romanov Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
description	BACKGROUND: A growing body of evidence demonstrates increasing prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in subjects with type 2 diabetes (T2D), while proportion of albuminuric pattern is decreasing. AIMS: To determine the clinical and laboratory parameters associated with different patterns of CKD in patients with T2D. METHODS: This observational, single-center, cross-sectional study included 360 patients with T2D duration ≥10 years. Patients with urinary albumin/creatinine ratio (UACR) <3 mg/mmol and estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2 were classified as no-CKD group (n=89). Patients with UACR <3 mg/mmol and eGFR <60 ml/min/1.73 m2 formed NA-CKD group (n=111). Individuals with eGFR ≥60 ml/min/1.73 m2 and UACR mg/mmol ≥3 were recorded as albuminuric with preserved renal function (A-CKD–, n=87). Patients with eGFR <60 ml/min/1.73 m2 and UACR mg/mmol ≥3 mg/mmol were considered as albuminuric CKD group (A-CKD+, n=73). Urinary nephrin and podocin, the podocyte injury markers, and whey acidic protein four-disulfide core domain protein 2 (WFDC-2), a marker of tubulointerstitial involvement, was assessed by ELISA and compared to control (20 non-diabetic subjects). RESULTS: Age ≥65 years (p=0.0001), duration of T2D ≥15 years (p=0.0009), female sex (p=0.04), and therapy with diuretics (p=0.0005) were found as risk factors for NA-CKD. The risk factors for A-CKD were male sex (p=0.01), smoking (p=0.01), waist-to-hip ratio >1 (p=0.01) and HbA1c levels >8% (p=0.005). The duration of T2D ≥15 years (p=0.01) and the use of dihydropyridine calcium channel blockers (p=0.01) were associated with A-CKD+. In T2D groups, the urinary excretion of nephrin and podocin was increased (all p<0.001), more markedly in albuminuric individuals (p<0.01 vs. NA-CKD). WFDC-2 excretion was increased in men from all diabetic groups (p<0.05) and in women with decreased eGFR only (p<0.05 vs. the control and NA-CKD). CONCLUSIONS: The CKD patterns in T2D are heterogeneous according to their clinical and laboratory characteristics. The changes in the excretion of nephrin and podocin indicate the association of albuminuric patterns with podocyte injury. A decrease in eGFR in women with T2D is associated with an increase in urinary excretion of WFDC-2, tubulointerstitial fibrosis marker.
format	article
author	Vadim V. Klimontov Anton I. Korbut Olga N. Fazullina Ilya V. Vinogradov Vyacheslav V. Romanov
author_facet	Vadim V. Klimontov Anton I. Korbut Olga N. Fazullina Ilya V. Vinogradov Vyacheslav V. Romanov
author_sort	Vadim V. Klimontov
title	Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
title_short	Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
title_full	Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
title_fullStr	Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
title_full_unstemmed	Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
title_sort	clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes
publisher	Endocrinology Research Centre
publishDate	2019
url	https://doaj.org/article/61d9f3457c714d6182d2aed91caa542f
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Clinical and laboratory characteristics of the patterns of chronic kidney disease in patients with type 2 diabetes

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