Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

Abstract

Objective: This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). Method:This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our hospital were collected. Patients were allocated to two groups of rapid decliners and slow decliners according to the median eGFR slope. The associations between potential risk factors and rapid eGFR decline were analyzed using logistic regression.Results: A total of 128 eligible patients were enrolled and they had a mean age of 51.5 ± 10.7 years. During a median follow-up of 2 years, the median eGFR slope was −8.1 ± 14.4 mL/min/1.73 m 2 /year. The eGFR decline was significantly faster in patients with a family history of diabetes in first-degree relatives, nephrotic-range proteinuria, higher grades of glomerular pathology, and interstitial inflammation. No differences in the rate of the eGFR decline were observed in subgroups created according to sex, age, hypertension, glycosylated hemoglobin, diabetic retinopathy, interstitial fibrosis, and tubular atrophy. Logistic regression indicated that a family history of diabetes was independently associated with a rapid decline in eGFR, even after adjustment for factors including baseline eGFR and proteinuria. Conclusion:A family history of diabetes in first-degree relatives is independently associated with a rapid decline in eGFR in the current relatively young studied patients. Our findings suggested that early diagnosis and treatment is important for these patients.

Early-onset of type 2 diabetes mellitus is a risk factor for diabetic nephropathy progression: a biopsy-based study

“…In our study, early-onset group presented higher proportion of DM family history, which was similar with previous studies [ 27 , 28 ]. A past study of our group also showed that patients with DN and family history of DM had more aggressive renal disease and rapidly falling in eGFR [ 29 ]. Other unknown factors remain further exploration.…”

Urinary complement proteins and risk of end-stage renal disease: quantitative urinary proteomics in patients with type 2 diabetes and biopsy-proven diabetic nephropathy

“…DN was defined according to the standard reported by An et al [ 18 ] in 2015 and was diagnosed by at least two renal pathologists and/or nephrologists based on the Renal Pathology Society (RPS) classification [ 19 ]. To accurately characterize trajectories of eGFR decline, we restricted our analysis to the following patients according to our previous study [ 20 ]: (1) those in whom serum creatinine levels were measured at least three times per year during the follow-up period; and (2) all serum creatinine assays were performed at our hospital to minimize methodological differences. Therefore, the exclusion criteria were: (1) coexisting non-diabetic kidney disease and systemic diseases, especially those involving antineutrophil cytoplasmic antibodies, such as vasculitis, antiglomerular basement membrane disease, and lupus nephritis; (2) nontype 2 diabetes; (3) progression to ESRD before renal biopsy; and (4) lack of trajectory of eGFR decline because serum creatinine levels were measured less than thrice annually at our hospital or performed at other hospitals (Supplementary Fig.…”

Renal outcomes and prognostic factors in patients with type-2 diabetes and chronic kidney disease confirmed by renal biopsy

“… 27 A recent study also showed that a family history of diabetes is an independent risk factor for rapid decline of eGFR in patients with DN. 28 We found that patients with a family history of diabetes are more likely to have adverse renal outcomes, suggests that the genetic background and lifestyle of diabetes may be related to the rapid decline of renal function in patients with DN.…”