Is the proteinuria an independent predict factor for diabetic kidney disease progression?

Authors

DOI:

https://doi.org/10.33448/rsd-v11i15.36895

Keywords:

Proteinuria; Diabetes Mellitus; Diabetes Complications; Renal Insufficiency, Chronic.

Abstract

Objective: To identify the association between proteinuria and the progression of kidney disease. Methods: A retrospective cohort study that analyzed the medical records of patients who attended a nephrology outpatient clinic between 2016 and 2021. Patients over 18 years, diagnosed with diabetes mellitus (DM) and who had data available in their medical records during the entire evaluation time, were included. Clinical variables (type of DM, duration of DM, systemic arterial hypertension (SAH), dyslipidemia, alcohol consumption, smoking, use of antiproteinuric drugs) and laboratory variables (renal function, blood glucose, glycated hemoglobin, counting blood cells) were evaluated. In the statistical analysis, binary logistic regression, backward and the forward types were used, performed in SPSS version 25 and with a significance level of 5%. Results: 384 patients were eligible for the study and 142 were patients with DM. Among these, 33 patients met all inclusion criteria and 31 (93.9%) had type 2 diabetes. A prevalence of proteinuria was observed in 24 patients (72.4%) at baseline. Of the sample, 30 (90.9%) were using antiproteinuric drugs, 18 (54.5%) had renal disease progression and simultaneous proteinuria during the follow-up. Only four patients did not present proteinuria during the study period. It is important to note that there was no significant association between proteinuria and renal function worsening. Conclusion: proteinuria was not significantly associated with Glomerular Filtration Rate (GFR) and, therefore, was not confirmed as an independent predict factor for the evolution of diabetic kidney disease (DKD).

References

American Diabetes Association (2020). 6. Glycemic Targets: Standards of Medical Care in Diabetes-2020. Diabetes care, 43(Suppl 1), S66–S76. https://doi.org/10.2337/dc20-S006.

Anders, H. J., Huber, T. B., Isermann, B., & Schiffer, M. (2018). CKD in diabetes: diabetic kidney disease versus nondiabetic kidney disease. Nature reviews. Nephrology, 14(6), 361–377. https://doi.org/10.1038/s41581-018-0001-y.

Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med. 2020 Oct 13;10(4):174-188. 10.4103/ajm.ajm_53_20

Budhiraja, P., Thajudeen, B. Popovtzer, M. (2013). Absence of albuminuria in type 2 diabetics with classical nephropathy: clinical pathological study. Journal of Biomedical Science Engineering, 6(5), 20-5.

Buyadaa, O., Magliano, D. J., Salim, A., Koye, D. N., & Shaw, J. E. (2020). Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes. Diabetes care, 43(1), 122–129. https://doi.org/10.2337/dc19-1438.

Chang, H. L., Wu, C. C., Lee, S. P., Chen, Y. K., Su, W., & Su, S. L. (2019). A predictive model for progression of CKD. Medicine, 98(26), e16186. https://doi.org/10.1097/MD.0000000000016186.

Cherney, D. Z., Perkins, B. A., Soleymanlou, N., Maione, M., Lai, V., Lee, A., Fagan, N. M., Woerle, H. J., Johansen, O. E., Broedl, U. C., & von Eynatten, M. (2014). Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation, 129(5), 587–597. https://doi.org/10.1161/CIRCULATIONAHA.113.005081.

Delgado, C., Baweja, M., Crews, D. C., Eneanya, N. D., Gadegbeku, C. A., Inker, L. A., Mendu, M. L., Miller, W. G., Moxey-Mims, M. M., Roberts, G. V., St Peter, W. L., Warfield, C., & Powe, N. R. (2022). A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. American journal of kidney diseases: the official journal of the National Kidney Foundation, 79(2), 268–288.e1. https://doi.org/10.1053/j.ajkd.2021.08.003.

Doshi, S. M., & Friedman, A. N. (2017). Diagnosis and Management of Type 2 Diabetic Kidney Disease. Clinical journal of the American Society of Nephrology: CJASN, 12(8), 1366–1373. https://doi.org/10.2215/CJN.11111016.

Dwyer, J. P., & Lewis, J. B. (2013). Nonproteinuric diabetic nephropathy: when diabetics don't read the textbook. The Medical clinics of North America, 97(1), 53–58. https://doi.org/10.1016/j.mcna.2012.10.006.

Ekinci, E. I., Jerums, G., Skene, A., Crammer, P., Power, D., Cheong, K. Y., Panagiotopoulos, S., McNeil, K., Baker, S. T., Fioretto, P., & Macisaac, R. J. (2013). Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes care, 36(11), 3620–3626. https://doi.org/10.2337/dc12-2572.

Feng, Y., Huang, R., Kavanagh, J., Li, L., Zeng, X., Li, Y., & Fu, P. (2019). Efficacy and Safety of Dual Blockade of the Renin-Angiotensin-Aldosterone System in Diabetic Kidney Disease: A Meta-Analysis. American journal of cardiovascular drugs: drugs, devices, and other interventions, 19(3), 259–286. https://doi.org/10.1007/s40256-018-00321-5.

Fox, C. S., Matsushita, K., Woodward, M., Bilo, H. J., Chalmers, J., Heerspink, H. J., Lee, B. J., Perkins, R. M., Rossing, P., Sairenchi, T., Tonelli, M., Vassalotti, J. A., Yamagishi, K., Coresh, J., de Jong, P. E., Wen, C. P., Nelson, R. G., & Chronic Kidney Disease Prognosis Consortium (2012). Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet (London, England), 380(9854), 1662–1673. https://doi.org/10.1016/S0140-6736(12)61350-6.

Guo, C., Martinez-Vasquez, D., Mendez, G. P., Toniolo, M. F., Yao, T. M., Oestreicher, E. M., Kikuchi, T., Lapointe, N., Pojoga, L., Williams, G. H., Ricchiuti, V., & Adler, G. K. (2006). Mineralocorticoid receptor antagonist reduces renal injury in rodent models of types 1 and 2 diabetes mellitus. Endocrinology, 147(11), 5363–5373. https://doi.org/10.1210/en.2006-0944.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplemments, 1–150.

Koszegi, S., Molnar, A., Lenart, L., Hodrea, J., Balogh, D. B., Lakat, T., Szkibinszkij, E., Hosszu, A., Sparding, N., Genovese, F., Wagner, L., Vannay, A., Szabo, A. J., & Fekete, A. (2019). RAAS inhibitors directly reduce diabetes-induced renal fibrosis via growth factor inhibition. The Journal of physiology, 597(1), 193–209. https://doi.org/10.1113/JP277002.

Koye, D. N., Magliano, D. J., Nelson, R. G., & Pavkov, M. E. (2018). The Global Epidemiology of Diabetes and Kidney Disease. Advances in chronic kidney disease, 25(2), 121–132. https://doi.org/10.1053/j.ackd.2017.10.011.

Koye, D. N., Magliano, D. J., Reid, C. M., Jepson, C., Feldman, H. I., Herman, W. H., & Shaw, J. E. (2018). Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: The CRIC (Chronic Renal Insufficiency Cohort) Study. American journal of kidney diseases: the official journal of the National Kidney Foundation, 72(5), 653–661. https://doi.org/10.1053/j.ajkd.2018.02.364.

Klimontov, V. V., & Korbut, A. I. (2019). Albuminuric and non-albuminuric patterns of chronic kidney disease in type 2 diabetes. Diabetes & metabolic syndrome, 13(1), 474–479. https://doi.org/10.1016/j.dsx.2018.11.014.

Krolewski, A. S., Niewczas, M. A., Skupien, J., Gohda, T., Smiles, A., Eckfeldt, J. H., Doria, A., & Warram, J. H. (2014). Early progressive renal decline precedes the onset of microalbuminuria and its progression to macroalbuminuria. Diabetes care, 37(1), 226–234. https://doi.org/10.2337/dc13-0985.

Larmour, K., & Levin, A. (2021). Slowing Progression in CKD: DAPA CKD and Beyond. Clinical journal of the American Society of Nephrology: CJASN, 16(7), 1117–1119. https://doi.org/10.2215/CJN.20211220.

Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. L., Castro, A. F., 3rd, Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., Coresh, J., & CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009). A new equation to estimate glomerular filtration rate. Annals of internal medicine, 150(9), 604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006.

Lotufo, P.A. (2016). Rastreamento para doença renal: Uma ferramenta em potencial para reduzir a desigualdade na saúde. São Paulo Medical Journal, 134(1), 1-2

Malta, M., Cardoso, L.O., Bastos, F.I., Magnanini, M.M.F., Silva, C.M.F.P. (2010). Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Revista de Saúde Pública, 44, 559-565.

Marshall S. M. (2014). Natural history and clinical characteristics of CKD in type 1 and type 2 diabetes mellitus. Advances in chronic kidney disease, 21(3), 267–272. https://doi.org/10.1053/j.ackd.2014.03.007.

Molitch, M. E., Steffes, M., Sun, W., Rutledge, B., Cleary, P., de Boer, I. H., Zinman, B., Lachin, J., & Epidemiology of Diabetes Interventions and Complications Study Group (2010). Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study. Diabetes care, 33(7), 1536–1543. https://doi.org/10.2337/dc09-1098.

Oshima, M., Shimizu, M., Yamanouchi, M. et al. Trajectories of kidney function in diabetes: a clinicopathological update. Nat Rev Nephrol 17, 740–750 (2021). https://doi.org/10.1038/s41581-021-00462-y

Radcliffe, N. J., Seah, J. M., Clarke, M., MacIsaac, R. J., Jerums, G., & Ekinci, E. I. (2017). Clinical predictive factors in diabetic kidney disease progression. Journal of diabetes investigation, 8(1), 6–18. https://doi.org/10.1111/jdi.12533.

Ruiz-Ortega, M., Rayego-Mateos, S., Lamas, S., Ortiz, A., & Rodrigues-Diez, R. R. (2020). Targeting the progression of chronic kidney disease. Nature reviews. Nephrology, 16(5), 269–288. https://doi.org/10.1038/s41581-019-0248-y.

Sagoo MK, Gnudi L. Diabetic Nephropathy: An Overview. Methods Mol Biol. 2020; 2067:3-7. doi: 10.1007/978-1-4939-9841-8_1. PMID: 31701441.

Shimizu, M., Furuichi, K., Yokoyama, H., Toyama, T., Iwata, Y., Sakai, N., Kaneko, S., & Wada, T. (2014). Kidney lesions in diabetic patients with normoalbuminuric renal insufficiency. Clinical and experimental nephrology, 18(2), 305–312. https://doi.org/10.1007/s10157-013-0870-0.

Thomas, M.C., Brownlee, M, Susztak, K. Sharma, K. JandeleitDahm, K.A. Zoungas, S. et al. (2015). Diabetic kidney disease. Nature Reviews Disease Primers, 2015, 1(1), 1-20.

Van Bommel, E., Muskiet, M., van Baar, M., Tonneijck, L., Smits, M. M., Emanuel, A. L., Bozovic, A., Danser, A., Geurts, F., Hoorn, E. J., Touw, D. J., Larsen, E. L., Poulsen, H. E., Kramer, M., Nieuwdorp, M., Joles, J. A., & van Raalte, D. H. (2020). The renal hemodynamic effects of the SGLT2 inhibitor dapagliflozin are caused by post-glomerular vasodilatation rather than pre-glomerular vasoconstriction in metformin-treated patients with type 2 diabetes in the randomized, double-blind RED trial. Kidney international, 97(1), 202–212. https://doi.org/10.1016/j.kint.2019.09.013.

Yamanouchi, M., Furuichi, K., Hoshino, J., Toyama, T., Hara, A., Shimizu, M., Kinowaki, K., Fujii, T., Ohashi, K., Yuzawa, Y., Kitamura, H., Suzuki, Y., Sato, H., Uesugi, N., Hisano, S., Ueda, Y., Nishi, S., Yokoyama, H., Nishino, T., Samejima, K., … Research Group of Diabetic Nephropathy, the Ministry of Health, Labour and Welfare, and the Japan Agency for Medical Research and Development (2019). Nonproteinuric Versus Proteinuric Phenotypes in Diabetic Kidney Disease: A Propensity Score-Matched Analysis of a Nationwide, Biopsy-Based Cohort Study. Diabetes care, 42(5), 891–902. https://doi.org/10.2337/dc18-1320

Zoccali, C., & Mallamaci, F. (2019). Nonproteinuric progressive diabetic kidney disease. Current opinion in nephrology and hypertension, 28(3), 227–232. https://doi.org/10.1097/MNH.0000000000000489

Zou, H., Zhou, B., & Xu, G. (2017). SGLT2 inhibitors: a novel choice for the combination therapy in diabetic kidney disease. Cardiovascular diabetology, 16(1), 65. https://doi.org/10.1186/s12933-017-0547-1.

Downloads

Published

14/11/2022

How to Cite

BRANDÃO, S. C.; FREITAS, S. B. de; CARVALHO, L. M. R.; ARAÚJO, L. C.; GUEDES, J. V. M.; OLIVEIRA, F. S. de; SILVA, F. M. de R. e; OTONI, A. Is the proteinuria an independent predict factor for diabetic kidney disease progression?. Research, Society and Development, [S. l.], v. 11, n. 15, p. e197111536895, 2022. DOI: 10.33448/rsd-v11i15.36895. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/36895. Acesso em: 27 apr. 2024.

Issue

Vol. 11 No. 15

Section

Health Sciences

License

Copyright (c) 2022 Sidnei Campidell Brandão; Stênio Barbosa de Freitas; Lívia Maria Rezende Carvalho; Layane Cristina Araújo; João Victor Marques Guedes; Fernanda Santos de Oliveira; Fernanda Marcelino de Rezende e Silva; Alba Otoni

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.