Albuminuric and non-albuminuric chronic kidney disease in type 1 diabetes: Association with major vascular outcomes risk and all-cause mortality

Garofolo, Monia; Russo, Eleonora; Miccoli, Roberto; Lucchesi, Daniela; Giusti, Laura; Sancho-Bornez, Veronica; Daniele, Giuseppe; Prato, Stefano Del; Penno, Giuseppe

doi:10.1016/j.jdiacomp.2018.03.012

Cited by 14 publications

(4 citation statements)

References 39 publications

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“…In the FinnDiane Study, the nonalbuminuric phenotype was associated with an increased risk of CVD and all-cause mortality to the same extent as individuals with albuminuria alone [45]. Likewise, in a study from Tuscany, the risk of all-cause death associated with reduced eGFR alone was similar to that of increased albuminuria alone, with the highest mortality occurring in T1D patients with both reduced eGFR and albuminuria [182].…”

Section: Diagnostic Prognostic and Therapeutic Implicationsmentioning

confidence: 91%

Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”

Pugliese¹,

Penno

Natali

et al. 2019

Nutrition, Metabolism and Cardiovascular Diseases

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Section: Diagnostic Prognostic and Therapeutic Implicationsmentioning

confidence: 91%

Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”

Pugliese¹,

Penno

Natali

et al. 2019

Nutrition, Metabolism and Cardiovascular Diseases

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Section: Box 14mentioning

confidence: 99%

Diabetic kidney disease: new clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”

et al. 2019

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Aims This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents. Data Synthesis Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., "nonalbuminuric renal impairment" and "progressive renal decline", suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered. Conclusions The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.

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“…Proteinuria remains a crucial independent predictor of eGFR decline in DM patients, especially those with low eGFR. However, even if the risk for ESRD was low, nonproteinuric patients showed an equal or even higher risk of CVD morbidity and mortality than those with proteinuria (33)(34)(35)(36)(37). The results suggest that nonproteinuric DN may represent a distinct phenotype, with macroangiopathic and tubulointerstitial lesions instead of microangiopathic lesions involved in the underlying pathology.…”

Section: Discussionmentioning

confidence: 87%

Clinical and Pathological Characteristics of Patients With Nonproteinuric Diabetic Nephropathy

Chang

et al. 2021

Front. Endocrinol.

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IntroductionAs the most common complication of diabetes mellitus (DM), diabetic nephropathy (DN) was initially considered to begin with proteinuria preceding the progression of renal insufficiency. This clinical paradigm has been questioned in the late decades, as many DM patients without proteinuria have progressive renal insufficiency. However, the characteristics of nonproteinuric DN were not fully clear yet.Patients and MethodsA total of 390 patients with renal biopsy-proven DN in our center were retrospectively recruited in the current study. Clinical and histopathological data of the patients were analyzed. We used propensity score-matching methods to address the imbalance of age, sex, and diabetes duration for comparative analyses.ResultsAmong all the renal biopsy-proven DN patients with renal biopsy proven DN, 18 patients were classified as nonproteinuric DN. Compared with 36 propensity score-matched proteinuric DN patients, diabetic retinopathy (DR) was less frequent in nonproteinuric DN patients (38.9% vs. 66.4%, p<0.05). During the follow-up of 24.0 (12.0–42.0) months, the probability of developing the end-stage renal disease (ESRD) was significantly lower in nonproteinuric DN patients than in proteinuric ones in both the propensity score-matched cohort and overall cohort (log-rank test, p<0.001 and p<0.001, respectively).ConclusionsCompared with proteinuric DN patients, DR was less frequent in nonproteinuric DN patients. Nonproteinuric DN patients had better renal outcomes than proteinuric DN patients.

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Albuminuric and non-albuminuric chronic kidney disease in type 1 diabetes: Association with major vascular outcomes risk and all-cause mortality

Cited by 14 publications

References 39 publications

Clinical and Pathological Characteristics of Patients With Nonproteinuric Diabetic Nephropathy

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