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Kidney Week

Abstract: SA-PO466

Diversity of Kidney Biopsy Findings Among Diabetic Patients in the Cleveland Clinic Kidney Biopsy Epidemiology Project

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Kwon, Alvin G., Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Sawaf, Hanny, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Shettigar, Shruti, Cleveland Clinic Florida, Weston, Florida, United States
  • Herlitz, Leal C., Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Kabuka, Adam, Cleveland Clinic Florida, Weston, Florida, United States
  • Gebreselassie, Surafel K., Cleveland Clinic Florida, Weston, Florida, United States
  • Bobart, Shane A., Cleveland Clinic Florida, Weston, Florida, United States
Background

Patients with a clinical diagnosis of diabetes without other criteria to prompt kidney biopsy are often treated and managed as diabetic kidney disease (DKD). We sought to describe the spectrum of kidney biopsy findings among patients with diabetes and identify factors associated with finding DKD and non-DKD (NDKD).

Methods

We identified patients with a history of diabetes from the Cleveland Clinic Kidney Biopsy epidemiology project from January 2015 to September 2021 using available ICD-10 code data.

Results

Of 4128 patients with native kidney biopsies, 3503 had ICD-10 code data. We identified 1271 (36.3%) with an ICD-10 coded diabetes. Of these, 462 (36.3%) had DKD alone and 678 (53.3%) had NDKD alone, 105 (8.3%) had both DKD and NDKD and 26 (2.0%) were either normal or non-diagnostic. The most common diagnoses among those with NDKD were FSGS (23.6%), global glomerulosclerosis NOS (12.8%), ATN (8.9%) IgA nephropathy (8.0%) and ANCA vasculitis (7.4%) and membranous nephropathy (4.9%).

When comparing types of NDKD between NDKD alone (n=678) and DKD+NDKD (n=105), global glomerulosclerosis NOS was more prevalent in NDKD alone group (13.9%, 5.7%). Oxalate nephropathy and PIGN were more prevalent in DKD+NDKD patients (4.8%, 0.9% and 11.4%, 3.5%, respectively). Aging and White race were positively associated with NDKD compared to DKD alone. (Table)

Conclusion

Of diabetic patients who underwent kidney biopsy, only 36.4% had DKD alone and 63.6% had additional diagnoses on biopsy. Aging had positive association with NDKD than DKD alone. Global glomerulosclerosis NOS, oxalate nephropathy and PIGN had different prevalence in NDKD versus DKD+NDKD. Further analysis is required and ongoing to determine factors associated with alternative diagnoses other than DKD among diabetes patients to guide the use of kidney biopsy in this setting.

Factors associated with NDKD among diabetes patients in CCKBEP
Multivariable models
(NDKD, n=783 vs. DKD alone, n=463)
Non-Diabetic Kidney Diseases
OR (95% CI)
Model A
Gender, female0.85 (0.67, 1.08)
Age at time of biopsy, per 1 year older0.020 (0.011, 0.028); beta coefficient
Race, self-identified White1.42 (1.11, 1.82)
Model B
Gender, female0.84 (0.66, 1.06)
Age at time of biopsy, >70 years old1.94 (1.46, 2.58)
Race, self-identified White1.44 (1.13, 1.84)

Funding

  • Private Foundation Support