Ingwiller Maxime, Delautre Arnaud, Tivollier Jean-Michel, Edet Stephane, Florens Nans, Couchoud Cécile, Hannedouche Thierry
Department of Nephrology, Hôpitaux Universitaires de Strasbourg, NHC 1 place de l'Hôpital, 67 000 Strasbourg, France.
Unité Néphrologie et Hémodialyse, BP 8267, 98807 Nouméa, France.
Kidney Med. 2024 Dec 13;7(2):100944. doi: 10.1016/j.xkme.2024.100944. eCollection 2025 Feb.
RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) in patients with diabetes does not always equate to diabetic kidney disease (DKD). This study aims to delineate and compare the clinical characteristics, survival rates, and access to kidney transplantation among patients with type 2 diabetes commencing dialysis, who were classified by kidney biopsy as having either DKD or non-diabetic kidney disease (non-DKD).
We used the comprehensive French Renal Epidemiology and Information Network registry to analyze baseline clinical characteristics at dialysis inception and outcomes defined as death and access to kidney transplantation.
OUTCOMES & ANALYTICAL APPROACH: We employed a multivariate Cox proportional hazards model and the Fine-Gray competing risk model to assess the probabilities of mortality and transplantation.
SETTINGS & PARTICIPANTS: Adults in the Renal Epidemiology and Information Network registry in France with a diagnosis of type 2 diabetes who initiated kidney replacement therapy from January 2009 to December 2015 and had a previous native kidney biopsy.
We analyzed data from 2,869 patients with diabetes, 45% of whom had a biopsy-confirmed diagnosis of DKD. Among these patients, half presented additional histopathological findings indicative of nephroangiosclerosis and focal segmental glomerulosclerosis. The clinical profiles of patients with DKD and non-DKD were largely comparable. There were no significant differences in dialysis survival rates or kidney transplantation access between the groups, even after adjusting for confounding variables and considering competing risks. At the 6-year mark, the mortality rate was 60.3% (95% CI: 55.5-64.5) for the DKD group and 60.3% (95% CI: 55.9-64.3) for the non-DKD group. Multivariable Cox analysis revealed no significant difference in mortality risk between the DKD and non-DKD groups.
The study limitations include potential residual confounders, lack of predialysis data, kidney biopsies possibly outdated, nonrandom biopsy indications, and survival bias because of analysis at dialysis inception.
In patients with diabetes initiating dialysis, clinical characteristics and outcomes following dialysis initiation were similar in biopsy-proven DKD versus non-DKD. Our results suggest that the diabetic milieu has a more significant impact on outcomes in patients with diabetes treated with dialysis than the underlying pathological kidney diagnosis.
糖尿病患者的慢性肾脏病（CKD）并不总是等同于糖尿病肾病（DKD）。本研究旨在描述并比较开始透析的2型糖尿病患者的临床特征、生存率及肾移植情况，这些患者经肾活检分为DKD或非糖尿病肾病（非DKD）。
我们使用法国肾脏流行病学和信息网络综合登记系统，分析透析开始时的基线临床特征以及定义为死亡和肾移植情况的结局。
我们采用多变量Cox比例风险模型和Fine-Gray竞争风险模型来评估死亡和移植的概率。
法国肾脏流行病学和信息网络登记系统中诊断为2型糖尿病且于2009年1月至2015年12月开始肾脏替代治疗并曾接受过肾活检的成年人。
我们分析了2869例糖尿病患者的数据，其中45%经活检确诊为DKD。在这些患者中，一半有额外的组织病理学表现提示肾血管硬化和局灶节段性肾小球硬化。DKD和非DKD患者的临床特征大致相似。即使在调整混杂变量并考虑竞争风险后，两组间的透析生存率或肾移植情况也无显著差异。在6年时，DKD组的死亡率为60.3%（95%CI：55.5 - 64.5），非DKD组为60.3%（95%CI：55.9 - 64.3）。多变量Cox分析显示DKD组和非DKD组之间的死亡风险无显著差异。
研究局限性包括潜在的残余混杂因素、缺乏透析前数据、肾活检可能过时、非随机活检指征以及因在透析开始时进行分析导致的生存偏倚。
在开始透析的糖尿病患者中，经活检证实的DKD与非DKD患者透析后的临床特征和结局相似。我们的结果表明，糖尿病环境对接受透析治疗的糖尿病患者结局的影响比潜在的肾脏病理诊断更大。
