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Bermejo, S. (Sheila); González, E. (Ester); López-Revuelta, K. (Katia); et al. "Risk factors for non-diabetic renal disease in diabetic patients". Clinical Kidney Journal. 13 (3), 2020, 380 - 388
Background. Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and
patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of
our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and
analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal
biopsy findings in patients with diabetes.
Methods. Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to
Results. In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 6 12.8 years, creatinine was 2.8 6 2.2 mg/dL
and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n ¼ 329) of patients had DN, 49.6% (n ¼ 413) NDRD and
10.8% (n ¼ 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n ¼ 87, 9.3%). In the multivariate
logistic regression analysis, older age [odds ratio (OR) ¼ 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR ¼ 1.51, 95%
CI: 1.03–2.21, P ¼ 0.033) and absence of diabetic retinopathy (DR) (OR ¼ 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently
associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal
prognosis than NDRD (P < 0.001) and higher mortality (P ¼ 0.029). In multivariate Cox analyses, older age (P < 0.001), higher
serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P ¼ 0.007) and DN (P < 0.001) were independent risk factors for
renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P ¼ 0.002), higher creatinine
(P ¼ 0.01) and DN (P ¼ 0.015) were independent risk factors for mortality.
Conclusions. The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are
the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD.
These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and
subsequently treatment and prognosis.