Kidney Week

Abstract: SA-PO546

Influence of Metabolic Phenotype and Non-Alcoholic Fatty Liver Disease in the Evolution of Renal Function in Diabetic Patients

Session Information

• Diabetic Kidney Disease: Pathology, Epidemiology
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Aubert, Lucia, Hospital Universitario 12 de Octubre, Madrid, Spain

Lucia Aubert,

• Sandino Perez, Justo, Hospital Universitario 12 de Octubre, Madrid, Spain

Justo Sandino Perez,

• Bada Bosch, Teresa, Hospital Universitario 12 de Octubre, Madrid, Spain

Teresa Bada Bosch,

• Trujillo Cuellar, Hernando, Hospital Universitario 12 de Octubre, Madrid, Spain

Hernando Trujillo Cuellar,

• Fernández vidal, María, Hospital Universitario 12 de Octubre, Madrid, Spain

María Fernández vidal,

• Canllavi fiel, Elizabeth, Hospital Universitario 12 de Octubre, Madrid, Spain

Elizabeth Canllavi fiel,

• Morales, Enrique, Hospital Universitario 12 de Octubre, Madrid, Spain

Enrique Morales,

Background

It has been described the albuminuric and normoalbuminuric phenotypes in diabetic nephropathy (DN). However, there is little information on the influence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MSd) on renal function in patients with type 2 diabetes mellitus (DM). The aim of this study was to compare the effect on renal function and proteinuria in patients with type 2 DM according to the presence of MSd.

Methods

Retrospective and observational study, including patients with type 2 DM, < 70 years of age and estimated glomerular filtration rate (eGFR) > 30 ml/min/1,73 m². MSd was defined as: obesity (body mass index > 30 kg/m²), hypertension and dyslipidaemia. Patients were classified according to the presence or absence of MSd. We analysed different clinical and analytical variables along the follow up.

Results

A total of 90 patients were included (61% males) with mean age of 57.9 7.6 years. The median evolution of type 2 DM was 64.8 months (38.7 – 117.8 months). When comparing patients with (group 1, n=39) and without (group 2, n=51) MSd at the beginning of this study, we found no significant difference in eGFR (80.5 39.7 ml/min vs 71.3 29.4 ml/min), proteinuria (1.4 1.1 g/24h vs 2.2 3.1 g/24h) and glycated haemoglobin (7.4 1.7% vs 6.8 1.2%). After a mean follow-up time of 74 months, we found significant differences in the loss of eFGR (group 1 4.9 ml/min/year vs group 2 2.6 ml/min/year; .013) and in increase of proteinuria (2.7 3.5 g/24h vs 1.0 1.3 g/24h; .02). We found an increase in incidence of chronic kidney disease in group 1 (26%) vs group 2 (16%). There were no differences in the need to initiate renal replacement therapy or all-cause mortality.
On a post hoc analysis, we evaluated the influence on renal function and proteinuria of NAFLD. Twenty eight out of 59 patients had NAFLD, observing a significant difference in loss of eFGR between those with and without NAFLD (32.7 ± 4.9 vs 29.7 ± 5.3; .03). There was also an increase in incidence of chronic kidney disease (32% vs 10%).

Conclusion

Metabolic phenotype and NAFLD in type 2 DM caused a mayor decline in renal function and increase in 24-hour proteinuria. Therefore, we should stratify patients with DKD to optimise treatment of associated risk factors.