Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
PeerJ. 2024 Feb 19;12:e16915. doi: 10.7717/peerj.16915. eCollection 2024.
Type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) poses a serious health threat and becomes a new challenge. T2DM patients with CKD fall into three categories, diabetic nephropathy (DN), non-diabetic kidney disease (NDKD), and diabetic nephropathy plus non-diabetic kidney disease (DN + NDKD), according to kidney biopsy. The purpose of our study was to compare the clinical characteristics and kidney outcomes of DN, NDKD, and DN + NDKD patients.
Data on clinical characteristics, pathological findings, and prognosis were collected from June 2016 to July 2022 in patients with previously diagnosed T2DM and confirmed DN and or NDKD by kidney biopsy at Tongji Hospital in Wuhan, China. The endpoint was defined as kidney transplantation, dialysis, or a twofold increase in serum creatinine.
In our 6-year retrospective cohort research, a total of 268 diabetic patients were admitted and categorized into three groups by kidney biopsy. The 268 patients were assigned to DN ( = 74), NDKD ( = 109), and DN + NDKD ( = 85) groups. The most frequent NDKD was membranous nephropathy (MN) ( = 45,41.28%). Hypertensive nephropathy was the most common subtype in the DN+NDKD group ( = 34,40%). A total of 34 patients (12.7%) reached the endpoint. The difference between the Kaplan-Meier survival curves of the DN, NDKD, and DN + NDKD groups was significant ( < 0.05). Multifactorial analysis showed that increased SBP [HR (95% CI): 1.018(1.002-1.035), = 0.025], lower Hb [HR(95% CI): 0.979(0.961-0.997), = 0.023], higher glycosylated hemoglobin [HR(95% CI): 1.338(1.080-1.658), = 0.008] and reduced serum ALB [HR(95% CI): 0.952(0.910-0.996), = 0.032] were risk factors for outcomes in the T2DM patients with CKD.
This research based on a Chinese cohort demonstrated that the risk of endpoint events differed among DN, NDKD, and DN+NDKD patients. In T2DM patients with CKD, DN patients displayed worse kidney prognosis than those with NDKD or DN + NDKD. Increased SBP, higher glycosylated hemoglobin, lower Hb, and decreased serum ALB may be correlated with adverse kidney outcomes in T2DM patients.
伴有慢性肾脏病（CKD）的 2 型糖尿病（T2DM）对健康构成严重威胁，成为新的挑战。根据肾活检结果，T2DM 合并 CKD 患者可分为糖尿病肾病（DN）、非糖尿病肾病（NDKD）和糖尿病肾病合并非糖尿病肾病（DN+NDKD）三类。本研究旨在比较 DN、NDKD 和 DN+NDKD 患者的临床特征和肾脏结局。
收集 2016 年 6 月至 2022 年 7 月期间在中国武汉同济医院接受诊断为 T2DM 并经肾活检确诊为 DN 和（或）NDKD 的患者的临床特征、病理发现和预后数据。终点定义为肾移植、透析或血清肌酐水平增加两倍。
在我们为期 6 年的回顾性队列研究中，共有 268 名糖尿病患者入院，根据肾活检结果分为三组。268 例患者被分为 DN（n=74）、NDKD（n=109）和 DN+NDKD（n=85）组。最常见的 NDKD 是膜性肾病（MN）（n=45，41.28%）。DN+NDKD 组最常见的亚型是高血压性肾病（n=34，40%）。共有 34 例（12.7%）患者达到终点。DN、NDKD 和 DN+NDKD 组之间的 Kaplan-Meier 生存曲线差异有统计学意义（P<0.05）。多因素分析显示，收缩压升高[风险比（HR）（95%可信区间）：1.018（1.002-1.035），P=0.025]、血红蛋白降低[HR（95%可信区间）：0.979（0.961-0.997），P=0.023]、糖化血红蛋白升高[HR（95%可信区间）：1.338（1.080-1.658），P=0.008]和血清白蛋白降低[HR（95%可信区间）：0.952（0.910-0.996），P=0.032]是 T2DM 合并 CKD 患者结局的危险因素。
本研究基于中国队列表明，DN、NDKD 和 DN+NDKD 患者的终点事件风险不同。在 T2DM 合并 CKD 患者中，DN 患者的肾脏预后较 NDKD 或 DN+NDKD 患者差。收缩压升高、糖化血红蛋白升高、血红蛋白降低和血清白蛋白降低可能与 T2DM 患者的不良肾脏结局相关。
