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Kidney Week

Abstract: PO0959

The Association Between Kidney Biopsy Findings in Diabetic Patients and Renal Replacement Therapy Initiation

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Vasquez jiménez, Enzo Christopher, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
  • Diez de Sollano Basila, Ana Lucia Lucia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
  • Osuna Padilla, Ivan Armando, Instituto Nacional de Enfermedades Respiratorias, Mexico, DF, Mexico
  • Soto, Virgilia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
  • Madero, Magdalena, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
Background

Diabetic Kidney Disease (DKD) is the leading cause of Chronic Kidney Disease (CKD) worldwide. Nevertheless, about a third of type 2 diabetic patients with kidney involvement have Non-Diabetic Kidney Disease (NDKD). The distinction between DKD and NDKD can only be done accurately with kidney biopsy. There is lack of evidence in regards to the association between NDKD and CKD progression. The objective of the study was to evaluate the association of DKD, NDKD or both with Renal Replacement Therapy (RRT) initiation.

Methods

This is a retrospective study of patients with T2DM who underwent a kidney biopsy between 2006 and 2019 at the Department of Nephrology at the National Institute of Cardiology in Mexico City. The included patients were followed for five years or until start of RRT. According to presence of diabetic nephropathy and non-diabetic glomerular disease, three groups were identified: group 1: patients with DKD, group 2: patients with NDKD and group 3: patients with combined DKD and NDKD.

Results

A total of 141 DM patients were included, the mean age was age 52.4 ± 12.2 years and 48.2%. The main indication for kidney biopsy was nephrotic proteinuria in 46 patients (32.6%), rapidly impaired kidney function in 23 patients (16.3%), nephrotic syndrome in 24 patients (17%) and suspicion of others glomerulopathies in 4 patients (2.8%). Based on kidney biopsy findings, 53 (39.1%) had DKD, 13 (9.2%) had NDKD and 75 (53.5%) had both DKD and NDKD. One hundred and four (74%) patients required RRT in the follow-up, 36 in DKD group, 10 in the NDKD group and 58 in the group with both DKD and NDKD. Patients with highest degree of fibrosis (grade 2 and 3 vs 1) (n =93) had a higher risk of starting RRT (RR 9.53, CI 95% 1.77- 51.3, p=0.009). Kidney survival was poorer in the DKD and NDKD group (p = 0.002) (Figure 1).

Conclusion

Kidney biopsies is this population could be of use in order to risk stratify this population. Subjects with the combination of DKD and NDKD have the worst renal prognosis.