Risk Factors For The Progression Of Diabetic Kidney Disease In Type 2 Diabetes Mellitus

Background Diabetic kidney disease(DKD)is one of the most important microvascular complications of diabetes mellitus.It is the main cause of death in type 1 diabetes,while in type 2 diabetes,only second to cardiovascular and cerebrovascular diseases.Specifically,it refers to kidney damage caused by long-term chronic hyperglycemia,which may involve renal structures including glomeruli,renal tubulointerstitials,and renal blood vessels.At present,the pathogenesis of DKD has not yet been fully elucidated.Research suggests that it may be related to abnormal glucose metabolism,changes in renal hemodynamics,oxidative stress,cytokines,and genetic factors.The main clinical features of DKD are persistent albuminuria and/or a progressive decline in glomerular filtration rate(GFR),which can eventually progress to end-stage renal disease(ESRD)with a higher incidence of cardiovascular disease as well as higher mortality.With poor prognosis and high medical costs,DKD becomes a heavy burden on patients and health care systems.In the western countries,DKD has become the most common cause of end-stage renal disease(ESRD).The prevalence of DKD in western countries is about 25%to 40%.In Chinese communities,it is reported that 10%to 50%patients with type 2 diabetes mellitus developed DKD.In China,DKD is the second leading cause of chronic kidney disease(CKD),close to the proportion of chronic glomerulonephritis.With the gradual change of the disease spectrum,the proportion of DKD in CKD and ESRD has gradually increased,and studies have confirmed that DKD progresses faster than other causes of chronic kidney disease.Therefore,looking for risk factors that influence and accelerate the progression of DKD thereby taking interventions is particularly important.At present,many studies have shown that there are many risk factors related to the development of DKD,including blood glucose,blood pressure,serum uric acid,proteinuria,etc.However,there is no universally accepted standard for the risk assessment for the progression of DKD progression.In patients with type 2 diabetes,the progression of DKD varies greatly between individuals,suggesting that risk factors for disease progression have not yet been fully recognized.Objective The aim of this study is to retrospectively analyze the clinical data of patients with type 2 diabetes mellitus who had been hospitalized in our department for many times,and to observe the progression of their kidney disease,explore the risk factors for the progression of DKD,providing a theoretical basis for the risk assessment of DKD progression.Method We retrospectively analyzed the clinical data of patients with both type 2 diabetes mellitus and diabetic kidney disease who were hospitalized more than twice in the Department of Endocrinology and Metabolism in our hospital between January 2007 and October 2017.The first time when they were diagnosed with diabetic kidney disease was considered as baseline,followed by subsequent hospitalization.Patients were divided into progressed group and unprogressed group according to their eGFR,proteinuria during follow-up.We analyzed the clinical data of the two groups before and after follow-up and Logistic regression was used to study the risk factors for the progression of diabetic kidney disease.Progression of diabetic kidney disease was defined as meeting one of the following criteria:(1)a drop in CKD GFR category from baseline(for example,from CKD G1-2 to G3a,G3a to G3b,G3b to G4,G4 to G5)accompanied by a 25%or greater drop in eGFR from baseline.(2)progression from normal and microalbuminuria(A1,A2 phase)to macroalbuminuria(A3 phase).(3)initiation of renal replacement therapy which includes dialysis,kidney transplantation or death due to kidney disease.Results A total of 194 patients with type 2 diabetes mellitus complicated with diabetic kidney disease were included,among which 130 were males and 64 were females.After a median follow-up of 27(15,45)months,118 cases were included in the progressed group and 76 cases were in the unprogressed group.The baseline SCr,BUN,UAER,ALB,Hb,Ca,DPN and the number of patients needing at least three kinds of antihypertension drugs were statistically different between the two groups(P<0.05).The SCr and prevalence of HBP in the two groups after follow-up was significantly higher than at baseline,and HbAlc and Hb decreased compared with baseline data.The median rate of decline in eGFR was 8.4%(2.0%,25.1%)in all patients,and the rate of decline in eGFR in the progressed group was significantly higher than that in the unprogressed group[18.4%(6.5%,42.2%)vs 2.4%(-1.0%,7.0).%)].Logistic regression analysis showed that the annual rate of decline in eGFR(OR=1.117,95%CI:1.067-1.170,P<0.001),glycated hemoglobin(OR=1.250,95%CI:1.032-1.514,P=0.022),need of taking three or more kinds of antihypertension drugs(OR=4.561,95%CI:1.230-16.909,P=0.023)were risk factors for the progression of diabetic kidney disease in patients with type 2 diabetes mellitus.Conclusion The annual rate of decline in eGFR,glycated hemoglobin,and the need of taking three or more kinds of antihypertension drugs are risk factors for the progression of diabetic kidney disease in patients with type 2 diabetes mellitus.In addition to the management of blood glucose,blood pressure and assessment of renal function in these patients,it is also necessary to pay attention to the rate of decline of renal function during the course of the disease.To evaluate the dynamic changes may provide more information for evaluating the risk of progression of diabetic kidney disease.