Background: When non-diabetic renal disease (NDRD) is suspected, kidney biopsy is used for definite diagnosis; however, this is not always easily available and may lead to complications. A clinical prediction score may help selecting appropriate patients for kidney biopsy.Methods: A retrospective cohort study was conducted in type 2 diabetes mellitus (T2DM) patients with atypical features of diabetic nephropathy (DN), who had kidney biopsy at Thammasat University Hospital from 2011-2019. We divided patients into NDRD alone, coexisting NDRD and DN, and DN alone, confirmed by pathological diagnosis. We developed a clinical prediction score by weighing coefficients of predictors in a multivariable logistic model. Internal validation was performed with bootstrapping.Results: We included 81 patients: 28 (34%) had NDRD alone, 15 (18%) had coexisting NDRD and DN, and 38 (41%) had DN alone. Primary membranous nephropathy, primary focal and segmental glomerulosclerosis (FSGS), and secondary FSGS were prevalent in any NDRD. Absence of diabetic retinopathy (DR) showed a significant association with any NDRD (OR 3.72; 95% CI, 1.28-10.8; p=0.02). The prediction score, AUC of 0.75 (95% CI, 0.63-0.86), had four predictors: duration of DM <10 years, eGFR >30 ml/min/1.73m2, HbA1c <8%, and absence of DR. Higher scores were associated with higher probability of NDRD.Conclusions: This clinical prediction score appears to be a useful tool to determine NDRD probability. T2DM patients with atypical presentation of DN with lower scores (0-2) may defer kidney biopsy.
In patients on chronic hemodialysis, there is no standard protocol for maintenance iron supplementation. This study aimed to compare two fixed-dose intravenous (IV) iron protocols to reduce erythropoiesis-stimulating agents (ESA). We conducted a double-blinded, randomized controlled study on hemodialysis patients having ferritin levels between 200 and 700 ng/dl and transferrin saturation values between 20 and 40%. Patients were assigned to receive either 100 or 200 mg of IV iron each month. ESA was adjusted every month to keep Hb between 10 and 12 g/dl. ESA dose at 12 months was the primary outcome. The secondary outcomes were all-cause mortality, cardiovascular events, absolute iron deficiency anemia (IDA), blood transfusion, adverse events, and iron withholding rate. Of the 79 eligible patients, 40 received 100 mg of IV iron, while 39 received 200 mg. At month 12, the mean monthly ESA dose in the 100-mg IV iron group was 35,706 ± 21,637 IU, compared to 26,382 ± 14,983 IU in the 200-mg group (P = 0.03). IDA was found in twelve patients (30%) in the 100-mg group and four patients (10.5%) in the 200-mg group (P = 0.05). In each group, three patients died (P = 0.9). Hospitalization, venous access thrombosis, and infection rates were similar in both groups. The withholding rate of IV iron was higher in 200-mg group (25% vs. 64.1%), but the protocol compliance was found more in 100-mg group (50% vs. 28.2%) (P = 0.001). In conclusion, monthly 200-mg IV iron infusions significantly reduce ESA doses but have a higher withholding rate. (Funded by the Kidney Foundation of Thailand and the Research Group in Nephrology and Renal Replacement Therapy from the Faculty of Medicine, Thammasat University).Thai Clinical Trials Registry number, TCTR20190707001.
Background: When non-diabetic kidney disease (NDKD) is suspected, biopsy proven is used for definite diagnosis. However, there are not always easily available and may lead to cause complications. A clinical prediction score may help selecting appropriate patients for kidney biopsy. Objective: To develop a clinical prediction score for distinguishing any type of NDKD (NDKD alone or coexisting NDKD and diabetic nephropathy [DN]) and DN alone. Materials and Methods: A retrospective cohort study was conducted in type 2 diabetes mellitus (T2DM) patients with atypical features of DN, who had kidney biopsy at Thammasat University Hospital between 2011 and 2019. The present study divided patients into NDKD alone, coexisting NDKD and DN, and DN alone, confirmed by pathological diagnoses. The authors developed a clinical prediction score by weighing coefficients of predictors in a multivariable logistic model. Internal validation was performed with bootstrapping. Results: The present study included 81 patients of which 28 (34%) had NDKD alone, 15 (18%) had coexisting NDKD and DN, and 38 (41%) had DN alone. Primary membranous nephropathy, primary focal segmental glomerulosclerosis (FSGS), and secondary FSGS were prevalent in any NDKD. Absence of diabetic retinopathy (DR) showed a significant association with any NDKD (adjusted OR 3.72; 95% CI 1.28 to 10.8; p=0.02). The prediction score, AUROC of 0.75 (95% CI 0.63 to 0.86), had four predictors, duration of DM of less than 10 years, eGFR of more than 30 mL/minute/1.73 m², HbA1c of less than 8%, and absence of DR. Higher scores were associated with higher probability of NDKD. Conclusion: The present study clinical prediction score appears to be a useful tool to determine NDKD probability. T2DM patients with atypical presentation of DN with lower scores (0 to 2) may defer kidney biopsy. Keywords: Non-diabetic kidney disease; clinical prediction score; kidney biopsy; type 2 diabetes mellitus
BackgroundWhen non-diabetic renal disease (NDRD) is suspected, kidney biopsy is used for definite diagnosis; however, this is not always easily available and may lead to complications. A clinical prediction score may help selecting appropriate patients for kidney biopsy. MethodsA retrospective cohort study was conducted in type 2 diabetes mellitus (T2DM) patients with atypical features of diabetic nephropathy (DN), who had kidney biopsy at Thammasat University Hospital from 2011-2019. We divided patients into NDRD alone, coexisting NDRD and DN, and DN alone, confirmed by pathological diagnosis. We developed a clinical prediction score by weighing coefficients of predictors in a multivariable logistic model. Internal validation was performed with bootstrapping.ResultsWe included 81 patients: 28 (34%) had NDRD alone, 15 (18%) had coexisting NDRD and DN, and 38 (41%) had DN alone. Primary membranous nephropathy, primary focal and segmental glomerulosclerosis (FSGS), and secondary FSGS were prevalent in any NDRD. Absence of diabetic retinopathy (DR) showed a significant association with any NDRD (OR 3.72; 95% CI, 1.28-10.8; p=0.02). The prediction score, AUC of 0.75 (95% CI, 0.63-0.86), had four predictors: duration of DM <10 years, eGFR >30 ml/min/1.73m2, HbA1c <8%, and absence of DR. Higher scores were associated with higher probability of NDRD.ConclusionsThis clinical prediction score appears to be a useful tool to determine NDRD probability. T2DM patients with atypical presentation of DN with lower scores (0-2) may defer kidney biopsy.
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