SP451DIABETIC NEPHROPATHY IN TYPE 2 DIABETES MELLITUS- ARE INDIANS RAPID PROGRESSORS?

Abstract

INTRODUCTION AND AIMS: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. The rate of decline of estimated glomerular filtration rate (eGFR) in DN is highly variable, ranging from 2 to 20 mL/min/1.73m2 per year. The KDIGO 2012 guidelines for the evaluation and management of CKD defines rapid decline in renal function as a sustained decline in eGFR of > 5mL/min/ 1.73m2 per year. Early detection and intervention in rapid progressors may help slow renal function decline and prevent complications, thereby improving survival and quality of life. However, risk factors for progression have not been fully elucidated. The aim of the present study was to assess rate of progression of diabetic nephropathy and identify factors associated with rapid progression. METHODS: This was a prospective observational study conducted between January 2016 and October 2017. All Type 2 diabetes mellitus (DM) patients aged≥18 years with DN and chronic kidney disease (CKD) Stage 1-5ND were included. DN was diagnosed clinically by presence of persistent albuminuria (>30mg/24 hours), with evidence of diabetic retinopathy and absence of clinical/laboratory suggestion of alternate cause of kidney disease. Those without diabetic retinopathy underwent kidney biopsy to confirm DN. Patients were followed up for a period of 6 months or till the end of the study period, whichever was longer. Demographic, clinical and laboratory data were collected. eGFR was calculated by Modification of Diet in Renal Disease (MDRD) formula. Acute kidney injury (AKI) (as per KDIGO 2012 guidelines) episodes, infections and cardiac events during follow-up period were noted. Rapid decline was defined as eGFR fall≥5mL/min/1.73m2/year and very rapid progression as eGFR decline ≥20ml/ min/1.73m2/year (Table presented). RESULTS: A total of 300 patients were included in the study. Mean duration of followup was 12.3 (63.97) months. Median rate of eGFR decline was 0.74 (Interquartile range (IQR) 0.23-1.8) mL/min/1.73m2 per month (9.6mL/min/1.73m2 per year) (Table 1), with rapid progression seen in 208 (69.3%) patients. This may be accounted for by the fact that 154 (51.3%) had proteinuria of ≥1g/day, and only 99 (33%) were on ACE inhibitors/angiotensin receptor blockers (ARBs). Rate of eGFR decline ≥20ml/ min/1.73m2 per year was seen in 73 (24.3%) patients. In this group, mean age was 54.79 610.6 years, with 57(78.1%) males and 16 (21.9%) females. Mean proteinuria was 2.1 62.46 g/dL. On univariate and multivariate analysis, younger age and proteinuria were the only factors found to be associated with very rapid progression (Table 2) CONCLUSIONS: The present study suggests rapid rate of progression of DN in Indians, with median eGFR decline of 0.74mL/min/1.73m2 per month (9.6mL/min/ 1.73m2 per year). Younger age and higher degree of proteinuria are associated with eGFR decline ≥20mL/min/1.73m2/year.