Abstract: TH-PO135
Association of Presence of Diabetes with Failure to Complete Remission of Idiopathic Membranous Nephropathy
Session Information
- Clinical Glomerular Disorders: FSGS, MN, MCD
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Xie, Huaiya, Peking Union Medical College Hospital, Beijing, China
- Wu, Zhen, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Zhang, Xin, Peking University First Hospital, Beijing, China
- Wen, Yubing, Peking Union Medical College Hospital, Beijing, China
- Cai, Jianfang, Peking Union Medical College Hospital, Beijing, China
- Li, Hang, Peking Union Medical College Hospital, Beijing, China
- Li, Xuemei, Peking Union Medical College Hospital, Beijing, China
- Li, Xuewang, Peking Union Medical College Hospital, Beijing, China
Background
This study aimed to assess whether the presence of diabetes will influence renal outcomes in patients with idiopathic membranous nephropathy (IMN).
Methods
In this retrospective study, a total of 875 patients with pathology-proved IMN were consecutively enrolled. Among them, 101 were diagnosed as type 2 diabetes mellitus (T2DM) prior to their diagnosis of IMN. Data on age, sex, body mass index (BMI), presence of hypertension and diabetes mellitus, laboratory tests, and therapeutic regimens were retrospectively retrieved from medical record. Complete remission (CR) was defined as urinary protein excretion<0.3g/d with stable estimated glomerular filtration (eGFR). COX regression was used to analyze risks of failure to CR and renal function deterioration associated with the presence of T2DM.
Results
A total of 810 patients were followed at least once with a median follow-up of 23.6 (IQR 9.9-42) months, of whom 292 achieved CR and 95 developed a 30% decline in eGFR. Presence of T2DM was associated with failure to reach CR of IMN (HR=0.53, 95% CI 0.37-0.77, P =0.001), independently of age, sex, hypertension, therapeutic regimen, serum albumin, proteinuria, and baseline eGFR. The association remained statistically significant when we further excluded 103 patients with corticosteroid-induced diabetes(HR=0.49, 95% CI 0.34-0.71，P <0.001), or restricted the analyses in patients with nephrotic syndrome(HR=0.46，95% CI 0.28-0.67，P =0.002) or in those using calcineurin inhibitors(HR=0.58，95% CI 0.37-0.91, P =0.017). However, patients with and without T2DM did not differ in developing a 30% decline in eGFR, adjusting for age, sex, BMI, state of smoking, hypertension, therapeutic regimen, serum albumin, proteinuria, and baseline eGFR(HR=0.67，95% CI 0.39-1.16，P =0.156).
Conclusion
Presence of T2DM may be independently associated with failure to remission but not eGFR decline in IMN patients.