Prognosis and risk factors of chronic kidney disease progression in patients with diabetic kidney disease and non-diabetic kidney disease: a prospective cohort CKD-ROUTE study

Abstract

Diabetic kidney disease (DKD) is emerging rapidly as the leading cause of chronic kidney disease (CKD) worldwide. In this 3-year prospective, multicenter cohort study, a total of 1138 pre-dialysis CKD patients were recruited. Patients were categorized into two groups according to the etiologies of DKD and non-diabetic kidney disease (NDKD). Propensity score matching was performed to adjust for confounding factors, resulting in 197 patients being assigned to DKD and NDKD groups, respectively. The primary endpoints were 50% estimated glomerular filtration rate (eGFR) decline and initiation of kidney replacement therapy (KRT). The secondary endpoints were all-cause death and the development of cardiovascular disease (CVD) events. We found that DKD patients have a higher risk to develop 50% eGFR decline endpoint (HR:2.30, 95%CI [1.48–3.58], p < 0.001) and KRT endpoint (HR:1.64, 95%CI [1.13–2.37], p < 0.05) than NDKD patients. The 3-year cumulative incidence of 50% eGFR decline and KRT endpoint was significantly higher in DKD patients (26.90% vs. 13.71% and 35.03% vs. 22.34%, respectively). The Cox regression analyses showed that the increased systolic blood pressure (SBP), DKD, decreased serum albumin (Alb), and higher CKD stages were risk factors for the 50% eGFR decline endpoint; the increased SBP, DKD, decreased serum Alb, serum creatinine (Scr), higher CKD stages, presence of proteinuria and CVD were risk factors for KRT endpoint; the increased age, decreased hemoglobin (Hb), decreased serum Alb were risk factors for all-cause death endpoint; the increased age, decreased serum Alb were risk factors for CVD events endpoint. Appropriate preventive or therapeutic interventions should be taken to control these predictive factors to delay the development of CKD complications, thereby improving the prognosis and reducing the disease burden of the high-risk populations.

Diabetes and chronic kidney disease in Chinese adults: a population-based cohort study

“…It is important to distinguish CKD subtypes, especially between DKD and non-diabetic kidney disease (NDKD) for disease prevention and clinical practice 15 16. A 3-year prospective, multicenter cohort study found that patients with DKD had a higher risk of a worse prognosis than NDKD (HR=2.30, 95% CI 1.48 to 3.58) 17. The present study is the first to explore the associations between DM and CKD subtypes and found that DM was associated with both DKD and NDKD (ie, glomerulonephritis) in Chinese adults.…”

Identification of a novel immune landscape signature as effective diagnostic markers related to immune cell infiltration in diabetic nephropathy

“…About 20%–40% of diabetes can progress to DN ( 1 ). It is a leading contributor of DN to kidney failure in developed countries ( 17 , 18 ). Therefore, early diagnosis and intervention in DN are particularly important.…”

Trend analysis and prediction of the incidence and mortality of CKD in China and the US

“…Diabetes is the most common cause of CKD worldwide. Compared to other causes of CKD, patients with CKD and diabetes are at a higher risk of developing end-stage renal disease (ESRD), which imposes a huge health and economic burden on both patients and society [17]. Hypertension is also a risk factor for CKD.…”