Kidney Week

Abstract: SA-PO286

Diabetic and Non-Diabetic Kidney Disease in Patients with Diabetes Mellitus (DM)

Session Information

• Clinical Glomerular Disorders: Vasculitis, C3G, IgAN
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Glomerular

• 1005 Clinical Glomerular Disorders

Authors

• Kim, Youngho, University of North Carolina, Chapel Hill, North Carolina, United States

Youngho Kim,

• Poulton, Caroline J., University of North Carolina, Chapel Hill, North Carolina, United States

Caroline J. Poulton,

• Hu, Yichun, University of North Carolina, Chapel Hill, North Carolina, United States

Yichun Hu,

• Hogan, Susan L., University of North Carolina, Chapel Hill, North Carolina, United States

Susan L. Hogan,

• Mottl, Amy K., University of North Carolina, Chapel Hill, North Carolina, United States

Amy K. Mottl,

• Falk, Ronald J., University of North Carolina, Chapel Hill, North Carolina, United States

Ronald J. Falk,

• Jennette, J. Charles, University of North Carolina, Chapel Hill, North Carolina, United States

J. Charles Jennette,

• Nachman, Patrick H., University of North Carolina, Chapel Hill, North Carolina, United States

Patrick H. Nachman,

Background

Glomerular and interstitial diseases occur in patients with DM, with or without concurrent diabetic nephropathy (DN). Limited data exists on the impact of DM and DN on the treatment and outcomes of patients with non-diabetic kidney disease (NDKD). We explored the characteristics, treatments and outcomes in a large cohort of patients with DM.

Methods

We reviewed medical records and kidney biopsy reports of patients with DM from the Glomerular Disease Collaborative Network and University of North Carolina. We grouped the patients into 3 categories based on pathologic diagnosis: DN alone, NDKD alone and concurrent DN+NDKD.

Results

382 patients with DM and kidney biopsy were identified: 53% male, 47% White, 40% Black, median age 55 years [IQR 46-64], BMI 30.9 kg/m² [26.8-36], eGFR 28 ml/min/1.73m² [16-49] and urine protein-creatinine ratio (UPCR) 5.5g/g [2.8-10.0]. Of these, 112 had DN, 180 had NDKD, and 90 DN+NDKD. Table 1 summarizes significant differences between these 3 groups. The DN+NDKD and NDKD groups differed significantly with respect to the distribution of glomerular and interstitial diseases (P=0.002). Lesions of FSGS were the most common in both groups (44% of DN+NDKD and 30% of NDKD). Interstitial nephritis was significantly more common in DN+NDKD (12% vs. 3%; P=0.007) and ANCA-GN more common in NDKD (7% vs 1%; P=0.04). Patients with NDKD received immunosuppressive therapy more frequently (64% vs 43% ) and had more frequent remission (69% vs 33%) compared to DN+NDKD.

Conclusion

The concurrence of NDKD and DN affect the likelihood of immunosuppressive therapy and of remission. Given the high prevalence of DM in the general U.S. population, an in-depth analysis of treatment, adverse effects and outcomes of patients with DM and NDKD is warranted.

Unless otherwise noted, data reported as median [IQR]. P values calculated using Fisher Exact test for categorical and Kruskal-Wallis test for continuous variables