| Objective:To retrospectively investigate the prevalence and distribution of Chronic Kidney Disease (CKD) in Chinese hospitalized adult patients with type 2 diabetes. To evaluate the relationship between peripheral nerve conductive velocity and Proteinuria. To assess the applicability of estimation equations for glomerular filtration rate in Chinese diabetic patients.Methods:Totally 1013 Chinese hospitalized adult patients with type 2 diabetes at HuaShan hospital from July 2007 to June 2009 were included in this study. The general situation of the patients were listed in the questionnaire by EpiData3.02. Weight, height, blood pressure,fasting blood glucose, postprandial blood sugar, Insulin, c-peptide, HbAlc, urea nitrogen, creatinine, uric acid, cholesterol, Triglyceride, high density lipoproteins, hemoglobin, hematocrit, urinary albumin creatinine ratio, Urine protein, Electromyography were investigated. CKD and DKD were defined and classified according to NKF-K/DOQI guideline. GFR was estimated by using of the abbreviated MDRD equation. The prevalence of chronic kidney disease was calculated respectively. The relationship between peripheral nerve conductive velocity and Proteinuria was evaluated. Glomerular filtration rate estimated with four glomerular filtration rate estimation formula were compared with 99mTc-DTPA plasma clearance by dual plasma sampling method in different stages of CKD.. All the data were analyzed by SPSS 16.0.Results:1. Chronic Kidney Diseaseⅰ. The prevalence rate of CKD in Chinese diabetic patients was 41.90% in our study, which was respectively distributed from stage I to V at the following percentage,9.08% (stage I),12.93% (stage Ⅱ),11.94% (stageⅢ),3.95% (stageⅣ),3.95% (stageⅤ).ⅱ. Diabetic kidney disease, Hypertensive nephropathy, Urinary tract obstruction were the leading cause of CKD, respectively accounting for 57.31%,9.91%,9.61%.ⅲ. The prevalence of chronic kidney disease increased with age. The prevalence of CKD in male and female were 40.8% and 43.4%, respectively, between which was no statistical significance.ⅳ. The patients with CKD were older and had long duration of diabetes, higher percentage with hypertension, hypercholesterolemia, hypertriglyceridemia than those patients without CKD. Systolic pressure, HbAlc, urea nitrogen, uric acid, creatinine, cholesterol, triglyceride, low density lipoprotein were increased in patients with CKD.ⅴ. The logistic regression analysis showed that the risk factors of CKD were age, HbA1c, creatinine, cholesterol, hypertension, proteinuria. Proteinuria was the first risk factor of CKD.2. Diabetic Kidney Diseaseⅰ. Diabetic kidney disease was the leading cause for chronic kidney disease in Chinese hospitalized patients with type 2 diabetes, accounting for 23.98% of prevalent kidney disease (male vs female 22.1% vs 26.85). The average age was 67.10±12.54 and the average course was 13.53+9.29.ⅱ. The abnormal rate of urine was 41.8% among those patients with type 2 diabetes in hospital. Microalbuminuria was found in 20.0%, and macroalbuminuria, in 16.5% of those with a history of type 2 diabetes after exclusion of acute urinary tract infection.ⅲ. The patients with DKD had long duration of diabetes, higher percentage with hypertension, hypercholesterolemia, hypertriglyceridemia than those patients without DKD. Systolic pressure, HbA1c, cholesterol, triglyceride, low density lipoprotein were increased, while high density lipoprotein were decreased in patients with DKD.ⅳ. The logistic regression analysis showed that the risk factors of DKD were course (OR:1.074, CI 1.046-1.103), HbA1c (OR:1.336, CI 1.206-1.480), creatinine (OR:1.063, CI 1.049-1.078),female (OR:3.644, CI 2.174-6.109), hypertension (OR:2.299, CI 1.328-3.982).3. Nerve conductive velocity and Proteinuriaⅰ. The abnormal rate of peripheral nerve conductive velocity in patients with CKD (57.3%) was significantly higher in those without CKD(33.3). The abnormal rate of peripheral nerve conductive velocity in patients with DKD(64.0%) was significantly higher in those without DKD(34.5%).ⅱ. Linear correlation analysis show that there was negative correlation between nerve conductive velocity and age, course of diabetes, urinary albumin creatinine ratio but no correction with fasting blood glucose. NCV of median nerve, ulnar nerve, tibial nerve were correlated negatively with HbA1c. SCV of superficial peroneal nerve, sural nerve were correlated negatively with eGFR.ⅲ. Peripheral nerve conductive velocity declined along with the aggravation of proteinuria from the comparison of indexes of EMG with normal albuminuria group, microalbuminuria group and macroalbuminuria group.ⅳ. The decline of peripheral nerve conductive velocity was significantly correlated negatively with urinary albumin creatinine after controlling for the variables of age, course, HbA1c, GFR by partial correction analysis.4. The application of glomerular filtration rate estimation formula and the development of new formulaⅰ.163 patients were selected to enter our study. The average age was 64.02±13.11, the average course was 9.90±7.83 and the average sGFR was 63.98±23.57 ml/min/1.73m2.ⅱ. There was significantly linear correlation between sGFR and eGFRwh which were calculated by four glomerular filtration rate estimation formula, Pearson Correlation coefficient were 0.740,0.680,0.756,0.722 respectively (P<0.01).ⅲ. GFR estimated by the abbreviated MDRD equation and the modify abbreviated MDRD equation showed better results than GFR estimated by Cockcroft-Gault equation and the refitting MDRD formula when compared the bias as well as the precision using Bland-Altman plot graph.ⅳ. The abbreviated MDRD equation, the modify abbreviated MDRD equation and the refitting MDRD equation overestimated the level of GFR. Cockcroft-Gault equation overestimated the level of GFR when GFR higher than 60 ml/min/1.73m2 and underestimated the level of GFR when GFR lower than 60 ml/min/1.73m2.ⅴ. Accuracy was measured as the percentage of eGFR mot deviativeing more than 30%,the modify abbreviated MDRD equation had high accuracy than the others when the level of sGFR greater than 60 ml/min/1.73m2; the four GFR estimation formula had low accuracy when the level of sGFR less than 60 ml/min/1.73m2.ⅵ. Using the level of sGFR less than 60 ml/min/1.73m2 as the diagnostic criteria of renal insufficiency, specificity of the four formulas were more than 90%, but sensitivity of four formula were no more than 60% diagnostic.Conclusion:1. The prevalence rate of CKD in Chinese diabetic patients was 41.90% in our study. Diabetic kidney disease, Hypertensive nephropathy, Urinary tract obstruction were the leading cause of CKD. The older was high risk group of chronic kidney disease. The risk factors of CKD were age, HbA1c, creatinine, cholesterol, hypertension, proteinuria. Proteinuria was the first risk factor of CKD.2. Diabetic kidney disease was the leading cause for chronic kidney disease in Chinese hospitalized patients with type 2 diabetes, accounting for 23.98% of prevalent kidney disease. Microalbuminuria was found in 20.0%, and macroalbuminuria, in 16.5% of those with a history of type 2 diabetes after exclusion of acute urinary tract infection. the risk factors of DKD were course, HbA1c, creatinine, female, hypertension.3. The type 2 diabetic patients with chronic kidney disease usually accompanied to peripheral neuropathy. There was negative correlation between nerve conductive velocity and age, course of diabetes, urinary albumin creatinine ratio.4. The abbreviated MDRD equation, the modify abbreviated MDRD equation, Cockcroft-Gault equation, the refitting MDRD formula should be amended when applying to Chinese type 2 diabetic patients in clinical practice.
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