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Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience.
Clin Exp Nephrol. 2017 Apr; 21(2):307-315.CE

Abstract

BACKGROUND

Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD.

METHOD

A total of 447 diabetic patients with advanced CKD, age of 18-80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score.

RESULTS

Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction.

CONCLUSIONS

Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system.

Authors+Show Affiliations

Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan. Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA.Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan. Department of Laboratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan. ckchiang@ntu.edu.tw. Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan. ckchiang@ntu.edu.tw. Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. ckchiang@ntu.edu.tw.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27339442

Citation

Chen, Ping-Min, et al. "Prognostic Value of Proteinuria and Glomerular Filtration Rate On Taiwanese Patients With Diabetes Mellitus and Advanced Chronic Kidney Disease: a Single Center Experience." Clinical and Experimental Nephrology, vol. 21, no. 2, 2017, pp. 307-315.
Chen PM, Wada T, Chiang CK. Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience. Clin Exp Nephrol. 2017;21(2):307-315.
Chen, P. M., Wada, T., & Chiang, C. K. (2017). Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience. Clinical and Experimental Nephrology, 21(2), 307-315. https://doi.org/10.1007/s10157-016-1290-8
Chen PM, Wada T, Chiang CK. Prognostic Value of Proteinuria and Glomerular Filtration Rate On Taiwanese Patients With Diabetes Mellitus and Advanced Chronic Kidney Disease: a Single Center Experience. Clin Exp Nephrol. 2017;21(2):307-315. PubMed PMID: 27339442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience. AU - Chen,Ping-Min, AU - Wada,Takashi, AU - Chiang,Chih-Kang, Y1 - 2016/06/23/ PY - 2016/02/23/received PY - 2016/06/01/accepted PY - 2016/6/25/pubmed PY - 2017/10/25/medline PY - 2016/6/25/entrez KW - Chronic kidney disease KW - Diabetes mellitus KW - Proteinuria SP - 307 EP - 315 JF - Clinical and experimental nephrology JO - Clin Exp Nephrol VL - 21 IS - 2 N2 - BACKGROUND: Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD. METHOD: A total of 447 diabetic patients with advanced CKD, age of 18-80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score. RESULTS: Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction. CONCLUSIONS: Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system. SN - 1437-7799 UR - https://www.unboundmedicine.com/medline/citation/27339442/Prognostic_value_of_proteinuria_and_glomerular_filtration_rate_on_Taiwanese_patients_with_diabetes_mellitus_and_advanced_chronic_kidney_disease:_a_single_center_experience_ L2 - https://dx.doi.org/10.1007/s10157-016-1290-8 DB - PRIME DP - Unbound Medicine ER -