MP430TYPE 2 DIABETIC PATIENTS WITH NON ALBUMINURIC KIDNEY DISEASE HAVE SLOWER GFR DECLINE - AN OBSERVATIONAL, 24−MONTH PROSPECTIVE COHORT STUDY

Abstract

Introduction and Aims: Kidney disease is common among type 2 diabetics and is associated with increased cardiovascular (CV) and mortality risk in this population. Diabetic kidney disease (DKD) presents with albuminuria and/or declined glomerular filtration rate (GFR). The aim of this study was to evaluate renal and CV outcomes in type 2 diabetic patients having declined GFR with and without albuminuria. Methods: This was an observational 24‐month prospective cohort study of type 2 diabetic patients with GFR < 60 mL/min. Patients were divided in two groups according to their albuminuric status ‐ non‐albuminuric DKD (NA‐DKD) and albuminuric DKD (A‐DKD). Albuminuria was defined as a random urinary albumin/ creatinine ratio (ACR) ≥ 30 mg/g. Results: The study included 104 patients, but only 74 completed the 24‐month follow‐up (13 patients died and 17 were lost during follow‐up). Forty‐four patients were males (59.5%), with mean age of 74.4 ± 8.9 years, median diabetes mellitus (DM) duration was 17 years, 91.9% had hypertension (HTN), median serum creatinine (SCr) was 1.4 mg/dL and median ACR was 49.1 mg/g. At baseline a total of 31 (41.9%) had NA‐DKD and 43 (58.1%) were A‐DKD. Age, gender, duration of DM, body mass index, smoke habits, metabolic control of DM, HTN prevalence and baseline GFR were not different between groups. Compared with patients with NA‐DKD, those with albuminuria showed faster decline of GFR (‐2.4 vs. +0.5 mL/min/year, p=0.021). This association was confirmed in a multivariate analysis adjusted to age, gender, baseline SCr and HTN (p=0.024). During the follow‐up, from the 13 deceased patients, 6 belonged to the NA‐DKD group and 7 to the A‐DKD group (p=ns). The rate of CV events were not different between groups either. At the end of the follow‐up, HTN control, number of hypotensive drugs, number of inpatient admissions, serum haemoglobin, development of ESRD or doubling serum creatinine, retinopathy, neuropathy, amputations and hospitalizations were not different between groups. Conclusions: The evolution of CKD in diabetic patients with non‐albuminuric phenotype is more indolent, with a slower decline of GFR. This knowledge could have screening, therapeutic and prognosis implications, which must be investigated in randomized controlled studies.