SP140GENDER DIFFERENCE IN CKD PATIENTS WITH DIABETIC NEPHROPATHY

Abstract

INTRODUCTION AND AIMS: Diabetes has a growing prevalence throughout the world with 422 millions of affected people in 2014, according toWHO. Diabetic nephropaty (DN) is a significant complication in terms of morbidity and mortality for patient with diabetes, being the main cause of cronic kidney disease in the United States and Western European country, frequently leading to end stage renal disease (ESRD). It is estimate that almost 40% of the patients with type I and type II diabetes mellitus have diabetic nephropathy (1). Persistent albuminuria (>300 mg/dl), progressive decline in glomerular filtration rate (GFR) and elevated arterial blood pressure are the main characteristic features of this syndrome. Sex-gender impact on diabetic nephropathy is not well determined, but some studies have shown that there are gender differences in evolution, risk factors and prognosis of renal impairment (2,3,4,5,6). AIMS. To determined the gender difference of chronic kidney disease (CKD) clinical manifestation, main risk factors and evolution in patients with diabetic nephropaty. METHODS: A retrospective observational study which included 108 patients with DN and CKD from the Nephrology Clinic of the Constanta County Hospital to which they have been noted demographic data, clinical and biological parameters, GFR, comorbidities RESULTS:: The mean age of the patients was 66.04611.104 years with male predominance (54.2%). Most patients are obese (69.5%) and have type 2 diabetes (T2DM) with insulin treatment in 67.8% cases.Women have a longer duration of diabetes than man (17.08 years versus 13.41 years with p=0.07), lower glycemic control than man (202.7 mg/dl versus 171.8 mg/dl with p<0.05) with a higher BMI (32.7 kg/m2 versus28.7 kg/ m2 with p<0.001). On the other hand, man have CKD in advanced stages (35.6% versus 25.4%, p<0.0001) and more diabetic complications than women (p<0.0001). Also men seems to lose more protein in urine than women-proteinuria in 24 hour in mens had an average of 2.06 gr compared to women of 1.44gr (p=0.40). Risk factors that have an additional influence on renal injury in men with diabetes are: obesity (RR=1.89, 95% confidence interval between1.272-2.747, p=0.007), dyslipidemia (RR=1.7, 95% confidence interval between 1.152-2.450, p=0.61 ) and hypertension (RR=1.85, 95%confidence interval between 1.444-2.389, p<0.05). To note that Asian patients in our group had an equal distribution of diabetic kidney disease on both genders (p<0.05) without any additional risk factor for disease severity. CONCLUSIONS: Althought women with diabetic nephropathy have poor glycemic control and increased BMI, they seems to develop CKD after a longer duration of diabetes than men. Moreover, in diabetic men kidney damage is more severe and is aggravated by the presence of obesity, dyslipidemia and hypertension.