Introduction:
Diabetic kidney disease has become a major cause of morbidity and mortality in low and middle income countries.Though there are many studies from western population regarding diabetic kidney disease , its progression and the factors influencing it, there are not many studies from India regarding the same. The primary goal of this study was to estimate the frequency of rapid progression of diabetic kidney disease (DKD),ie, GFR decline more than 10 ml/ min/1.73 m2/year among our population and to identify clinical, biochemical, and demographic indicators that may indicate an accelerated deterioration in renal function.
Methods:
Ours was a prospective observational study. The study population consisted of 185 diabetic nephropathy patients with an eGFR less than or equal to 59 ml/min/1.73m2(CKD Stage 3a or higher). The patients were followed up for 1 year and the GFR after 1 year was calculated. GFR was calculated using the CKD-EPI formula using creatinine. The difference in GFR after 1 year was calculated , proportion of rapid progressors was determined and the factors influencing the same were assessed for association using univariate and multivariate analysis. Proprotion of non proteinuric kidney disease was also estimated.
Results:
Our study has shown that the decline in GFR is more rapid in our population compared to data from Western countries. 37.8% experienced rapid progression, defined as a GFR decrease of 10 mL/min per 1.73 m² or more. The factors which got significant association with rapid progression after univariate analysis were age >60 years, duration of CKD less than 5 years, systolic blood pressure more than 150 mm hg, number of antihypertensives more than 2. Higher urine PCR at 0,3,6 and 12 months had significant association with rapid progression. Higher RBS and HbA1C ,higher total cholesterol and triglyceride levels, higher total leucocyte count, ESR , uric acid , phosphorus and a lower albumin had statistically significant association with rapid progression. Urinary tract infection, calculi in USG, recent NSAID use, alternative medicine use also had significant correlation with rapid progression. SGLT2 inhibitor use and non proteinuric kidney disease were found to have significantly lower rapid progression. 8.1% of our patients had DKD without overt proteinuria (urine protein creatinine ratio< 0.3) and such patients got significantly lower rapid progression during univariate analysis. After multivariate analysis high baseline urine PC ratio, higher baseline creatinine, higher RBS, HBA1C, uric acid and phosphorus levels and alternative medicine use retained their significance.
Conclusions:
Diabetic kidney disease patients are more likely to have rapid decline in GFR or rapid progression of renal failure if they have uncontrolled sugars and blood pressure. Strict control of proteinuria deserves special mention as a factor to retard the progression of disease. Employing drugs like SGLT2 inhibitors is a necessity.An optimal control of other metabolic parameters including total cholesterol, triglyceride levels is also essential to prevent the rapid progression. Avoiding episodes of urinary tract infections, control of inflammation, optimal nutrition aiming better control over parameters like albumin, phosphorus are essential factors to control the disease progression. Patient counselling regarding factors like pain management and avoiding the use of complementary and alternative medication use should also be a part of routine management in DKD patients. Early intervention is a cornerstone in the control of DKD and individualized treatment plans considering the age and stage of CKD should be used.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.