Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy - PubMed (original) (raw)

Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy

Kyung Jin Yun et al. Diabetes Metab J. 2016 Dec.

Abstract

Background: Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR.

Methods: We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years.

Results: The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD.

Conclusion: The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

Keywords: Cholesterol, HDL; Diabetes mellitus, type 2; Diabetic nephropathies; Diabetic retinopathy; Hemoglobin A1c protein, human; Triglycerides.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1

Fig. 1. The mean (A) urine albumin/creatinine ratio (uACR; µg/mg) or (B) estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) and 95% confidence interval according to four quartiles (Q1, Q2, Q3, and Q4) of indices of glycosylated hemoglobin (HbA1c) variability and the triglyceride (TG)/high density lipoprotein cholesterol (HDL-C) ratio in patients with type 2 diabetes mellitus and advanced diabetic retinopathy were presented in the figure. Median and interquartile ranges of indices of HbA1c variability were 0.56 (0.35 to 0.78) for HbA1c-standard deviation (SD), 0.51 (0.32 to 0.72) for adjusted (Adj)-HbA1c-SD and 0.07 (0.05 to 0.10) for HbA1c-coefficient of variation (CV), respectively. Median and interquartile ranges of indices of the TG/HDL-C ratio were 2.9 (1.8 to 4.5). All P for trend <0.05 by analysis of variance.

References

    1. Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH American Diabetes Association. Diabetic nephropathy. Diabetes Care. 2003;26(Suppl 1):S94–S98. - PubMed
    1. Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL, 3rd, Klein R American Diabetes Association. Retinopathy in diabetes. Diabetes Care. 2004;27(Suppl 1):S84–S87. - PubMed
    1. Kramer CK, Retnakaran R. Concordance of retinopathy and nephropathy over time in type 1 diabetes: an analysis of data from the Diabetes Control and Complications Trial. Diabet Med. 2013;30:1333–1341. - PubMed
    1. Penno G, Solini A, Zoppini G, Orsi E, Zerbini G, Trevisan R, Gruden G, Cavalot F, Laviola L, Morano S, Nicolucci A, Pugliese G Renal Insufficiency And Cardiovascular Events (RIACE) Study Group. Rate and determinants of association between advanced retinopathy and chronic kidney disease in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study. Diabetes Care. 2012;35:2317–2323. - PMC - PubMed
    1. Magri CJ, Calleja N, Buhagiar G, Fava S, Vassallo J. Factors associated with diabetic nephropathy in subjects with proliferative retinopathy. Int Urol Nephrol. 2012;44:197–206. - PubMed

LinkOut - more resources