Espectro de la nefropatía diabética en el siglo XXI

Abstract

Abstract Diabetic nephropathy still remains as the most frequent cause of end stage renal disease (ESRD) in our population despite the improvements established in the glycemic control, blood pressure and nephroprotective treatment with Renin Angiotensin Aldosterone inhibitors. The better knowledge of the actual phenotype of Diabetic Kidney Disease (DKD) and the identification of new biomarkers could optimize the treatment and improve the prognosis of DKD. With this objective we designed this prospective, observational study with 261 patients with DM referred to DKD outpatient clinic, followed up for 30 months, registering clinical and analytical variables at baseline, and looking for predicting factors for rate of progression of renal function, albuminuria, need for renal replacement therapy or decease and the combination of these events. Results: In general, the global prognosis of the population was satisfactory, with a loss of glomerular filtration rate (eGFR) similar to the expected due to age (-1 ml/min/1,73 m²/year). Nevertheless, in more advance stages of renal disease (G4), albuminuria did not decrease, being associated with a worst prognosis of the patients. There were differences between men and women in the magnitude of albuminuria, in the prevalence of other risk factors and the prognosis of renal function. In patients with rapid progression (eGFR>5 ml/min/1,73m² of renal function loss) during the follow up, UACR had poor predictive value in women. In this regard, the proteomic biomarker CKD273 could be studied as a marker of progression in women. During the follow up 44/261patients died (17%), 32/170 (19%) men and 12/91 (13%) women. Women had lower risk of mortality than men in the analysis adjusted by age, UACR and eGFR. Finally, prognosis in elderly population (higher tercile,>75,8 years/old) was not worse than younger subjects. There were not differences among terciles in the eventually need of renal replacement therapy and the cutoff point that made the difference, mortality was 63,5 years. Urinary biomarker CKD273 was associated with the presence of DKD. Tesis Doctoral Beatriz Fernández Fernández. Espectro de la Nefropatía diabética en el Siglo XXI Conclusions: In spite of the global evolution of DKD patients treated in accordance with the “state of the art” in the DKD is correct, there are differences between sexes, being albuminuria a poor predictor of rapid progression in women. Moreover, in patients within stage G4 the efficacy of the treatment substantially decreases, so, early referral to the nephrologists is of importance. New biomarkers as urinary marker CKD273 are a promise in prediction of the progression of DKD. Tesis Doctoral Beatriz Fernández Fernández. Espectro de la Nefropatía diabética en el Siglo XXI