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Kidney Week

Abstract: SA-PO545

Association of Urinary Acidification Function with the Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Yuan, Yanggang, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Xing, Chang Ying, First Affiliated Hospital of Nanjing Medical University, Nanjing, JIangSu, China

Although diabetic kidney disease (DKD) has been considered as a glomerulocentric disease in the past few decades, growing evidence demonstrated that tubular damage is indispensable in its pathogenesis and progression. This study was designed to investigate the association of urinary acidification dysfunction with the progression of DKD in type 2 diabetic patients.


Here we measured the urinary acidification function from 80 participants with renal biopsy-proven DKD. The different kinds of renal tubular transportation dysfunction were analyzed by urinary acidification function, including the dysfunction of bicarbonate reabsorption, titratable acid secretion, and ammonium secretion. In addition, patients were followed up for 17 (interquartile range, 11-32) months to evaluate the effect of urinary acidification dysfunction in the progression of DKD.


The dysfunction of ammonium secretion was the most common, accounting for 53.75%. The more proteinuria excretion and the lower glomerular filtration rate (GFR) were observed in the urinary titratable acid secretion disorder group than the normal group, and the same results were obtained for ammonium secretion disorder. Urine titratable acid was positively correlated with eGFR whereas it was inversely correlated with proteinuria, serum creatinine, and BUN. Moreover, 24h urine protein, serum creatinine, BUN and cystatin C increased from DKD stage II to stage IV, whereas the eGFR and urine titratable acid decreased in the same way. Furthermore, Kaplan-Meier analysis and Cox regression showed that the dysfunction of titratable acid secretion was an independent risk factor of DKD progression.


The dysfunction of titratable acid secretion is a potential biomarker for the severity of proteinuria, eGFR and glomerular lesions in patients with DKD. Moreover, the titratable acid secretion disorder is an independent risk factor of the DKD progression.