Kidney Week

Abstract: SA-PO462

Progression to ESKD in Type 2 Diabetes by Histological Findings: A Retrospective Cohort Study

Session Information

• Diabetic Kidney Disease: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Haar, Karina, Department of Medicine, Zealand University Hospital, Roskilde, Denmark

Karina Haar,

• Persson, Frederik, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark

Frederik Persson,

• Bressendorff, Iain Oshoj, Department of Nephrology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark

Iain Oshoj Bressendorff,

• Hansen, Ditte, Department of Nephrology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark

Ditte Hansen,

• Møller, Marie, Department of Nephrology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark

Marie Møller,

• Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Denmark

Peter Rossing,

• Borg, Rikke, Department of Medicine, Zealand University Hospital, Roskilde, Denmark

Rikke Borg,

Group or Team Name

• PRIMETIME.

Background

The risk of progression to end-stage kidney disease (ESKD) varies among individuals with type 2 diabetes (T2D). This study aims to investigate if the risk of progression to ESKD differ by biopsy-proven type of kidney disease.

Methods

We conducted a retrospective cohort study including all adults with T2D in Denmark from 1996-2020 who had a kidney biopsy performed. The individuals were previously classified as having diabetic nephropathy (DN) (n=599), non-diabetic nephropathy (NDN) (n=703), mixed disease (n=165), normal histopathology (n=49), or could not be classified (NC) (n=743). Using high-quality national registry data, the cohort was described with demographic, clinical, and laboratory data and comorbidity. Stratified analysis of progression to ESKD within the type of kidney disease was performed.

Results

The cohort consisted of 68% men with mean age 64.1+11.2 years at biopsy. At the time of biopsy, the DN group had systolic blood pressure (SBP) 144±20 mmHg and a body mass index (BMI) of 30.9±6.2 kg/m². They had a median and interquartile range [IQR] estimated glomerular filtration rate (eGFR) 39 [24.0, 59.2] ml/min/1.73m² and median [IQR] urine albumin-creatinine ratio (UACR) 2373 [890.2, 4183.5] mg/g. The NDN group had SBP 138±21 mmHg, a BMI of 30.8±6.5 kg/m², eGFR 29 [15.0, 58.0] ml/min/1.73m², and UACR 766 [95.5, 2394.5] mg/g. The mixed disease group had SBP 147±21 mmHg, a BMI of 31.7±6.1 kg/m², eGFR 25 [11.0, 48.0] ml/min/1.73m² and UACR 1863 [583.0, 3400.0] mg/g. We found a significant difference in the rate of renal progression (p < 0.001). During a median follow-up of 12.8 years, progression to ESKD occurred in 52% with DN, 42% with NDN, 53% with mixed disease, 25% with normal histopathology, and 41% with NC. Time to ESKD from diagnosis of T2D was significantly different within the type of kidney disease (p < 0.001); 13.2 [8.0, 17.9] median [IQR] years in DN, 7.8 [4.5, 12.8] years in NDN, 13.0 [7.8, 17.3] years in mixed disease, 6.3 [1.3, 11.1] years in normal histopathology, and 9.2 [5.1, 14.6] years in NC.

Conclusion

In people with T2D, we found the highest rate of ESKD in DN and mixed disease, but with the slowest time to progression. Analyses suggest that the risk of and time until progression to ESKD differs significantly within types of biopsy-proven kidney disease.

Funding

• Private Foundation Support