Clinical predictive factors in diabetic kidney disease progression

Abstract

Diabetic kidney disease (DKD) represents a major component of the health burden associated with type 1 and type 2 diabetes. Recent advances have produced an explosion of ‘novel’ assay‐based risk markers for DKD, though clinical use remains restricted. Although many patients with progressive DKD follow a classical albuminuria‐based pathway, non‐albuminuric DKD progression is now well recognized. In general, the following clinical and biochemical characteristics have been associated with progressive DKD in both type 1 and type 2 diabetes: increased hemoglobin A1c, systolic blood pressure, albuminuria grade, early glomerular filtration rate decline, duration of diabetes, age (including pubertal onset) and serum uric acid; the presence of concomitant microvascular complications; and positive family history. The same is true in type 2 diabetes for male sex category, in patients following an albuminuric pathway to DKD, and also true for the presence of increased pulse wave velocity. The following baseline clinical characteristics have been proposed as risk factors for DKD progression, but with further research required to assess the nature of any relationship: dyslipidemia (including low‐density lipoprotein, total and high‐density lipoprotein cholesterol); elevated body mass index; smoking status; hyperfiltration; decreases in vitamin D, hemoglobin and uric acid excretion (all known consequences of advanced DKD); and patient test result visit‐to‐visit variability (hemoglobin A1c, blood pressure and high‐density lipoprotein cholesterol). The development of multifactorial ‘renal risk equations’ for type 2 diabetes has the potential to simplify the task of DKD prognostication; however, there are currently none for type 1 diabetes‐specific populations. Significant progress has been made in the prediction of DKD progression using readily available clinical data, though further work is required to elicit the role of several variables, and to consolidate data to facilitate clinical implementation.

Clinical and biochemical aspects associated with diabetic nephropathy among type 2 diabetic males in Gaza strip

“…the longer the duration of diabetes, the more the progression of DN. Similar results were documented (Viswanathan et al 2012; Radcliffe et al 2017). In addition, diagnosed complications, including retinopathy, CVD and neuropathy were significantly more frequent in patients with DN than in patients without DN.…”

“…In this context, logistic regression model revealed that the predicted factors of DN were duration of diabetes, smoking, retinopathy, CVD, neuropathy, glucose, urea, creatinine, cholesterol, LDL-C and GFR. Most of these factors were identified as clinical and biochemical predictive factors in diabetic kidney disease progression (Grover et al 2012;Radcliffe et al 2017). However, the exact stage of DN is beyond the scope of this study.…”

Prediction of Nephropathy in Type 2 Diabetes: An Analysis of the ACCORD Trial Applying Machine Learning Techniques

“…The importance of cholesterol control in T2DM was also important throughout the study ( Table ). Although not many studies have reported HDL as a risk factor to develop DN, these findings seem to be in agreement with previous reports suggesting dyslipidemia as a potential risk marker for diabetic kidney disease . Other investigations have reported a cross‐sectional relationship between the lipid‐subtype “fingerprint” and advanced kidney disease .…”

“…The inclusion of time varying attributes in the analysis may be advantageous to predict the outcome. Interestingly, the slopes of change after years 1, 2, and 3 of the study (s1., s2., and s3.Trig in Table ) became important predictors beginning at year 2, suggesting that the lipid control over time is extremely important in patients with T2DM, especially in those with cardiovascular risks who have shown a correlation with dyslipidemia under such conditions …”

The association between thyroid dysfunction (TD) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM)

“…An estimated 382 million people around the world had diabetes in 2013, a number that is expected to rise to 592 million by 2035 . Diabetic kidney disease (DKD) is one of the primary micro‐vascular complications of the disease, and is the leading cause of chronic kidney disease (CKD) and end‐stage renal/kidney disease (ESRD/ESKD) . DKD is typically represented by damage to the glomerulus, interstitium and blood vessels; however, its pathogenesis and molecular mechanisms are not fully understood .…”