Diabetes Metab J.  2016 Dec;40(6):473-481. 10.4093/dmj.2016.40.6.473.

Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy

• Yun KJ
• Kim HJ
• Kim MK
• Kwon HS
• Baek KH
• Roh YJ
• Song KH

• KMID: 2362220
• DOI: http://doi.org/10.4093/dmj.2016.40.6.473

Abstract

BACKGROUND
Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR.
METHODS
We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years.
RESULTS
The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD.
CONCLUSION
The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

Keyword

Cholesterol, HDL; Diabetes mellitus, type 2; Diabetic nephropathies; Diabetic retinopathy; Hemoglobin A1c protein, human; Triglycerides

MeSH Terms

Blood Pressure
Cholesterol
Cholesterol, HDL
Cross-Sectional Studies
Diabetes Mellitus, Type 2*
Diabetic Nephropathies*
Diabetic Retinopathy*
Glomerular Filtration Rate
Hemoglobin A, Glycosylated
Humans
Linear Models
Lipoproteins
Logistic Models
Phenotype
Prevalence
Risk Factors*
Triglycerides
Cholesterol
Cholesterol, HDL
Lipoproteins
Triglycerides

Figure

• 

  Fig. 1 The mean (A) urine albumin/creatinine ratio (uACR; µg/mg) or (B) estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) and 95% confidence interval according to four quartiles (Q1, Q2, Q3, and Q4) of indices of glycosylated hemoglobin (HbA1c) variability and the triglyceride (TG)/high density lipoprotein cholesterol (HDL-C) ratio in patients with type 2 diabetes mellitus and advanced diabetic retinopathy were presented in the figure. Median and interquartile ranges of indices of HbA1c variability were 0.56 (0.35 to 0.78) for HbA1c-standard deviation (SD), 0.51 (0.32 to 0.72) for adjusted (Adj)-HbA1c-SD and 0.07 (0.05 to 0.10) for HbA1c-coefficient of variation (CV), respectively. Median and interquartile ranges of indices of the TG/HDL-C ratio were 2.9 (1.8 to 4.5). All P for trend <0.05 by analysis of variance.

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