Back
Diabetes Mellitus (DM) can progress to Diabetic Kidney Disease (DKD) in 40% of cases. Albuminuria has a significant impact on clinical outcomes: Cardiovascular Disease (CVD), diabetic retinopathy, neuropathy, and quality of life, as well as premature death. Aim: Identify the clinical and demographic profile of outpatients with DKD from a tertiary/quaternary hospital in order to assess the need for clinical management adjustment for metabolic control and to reduce the risk of unfavorable outcomes.
We conducted a retrospective cross-sectional study by collecting data from 1,156 medical records. We selected 642 patients who were active between 2019 and 2022. Out of those, 202 were excluded due to a lack of albuminuria measurements and being on kidney replacement therapy (KRT). We analyzed 440 in the end, classified according to KDIGO and CKD-EPI values and albuminuria.
Most patients were in stage G5A3, followed by G4A3. The mean age was 65±13.17 years, and CKD-EPI was 31±21.18 ml/min. The prevalence of female patients was 56%, and only 5% had type 1 diabetes (T1D). Regarding glycated hemoglobin, 37% had a value >8%, with an average of 7.7±1.6%. The average values for other parameters were: abdominal circumference 105±14.2 cm; BMI 29±5.3 kg/m²; blood pressure 135/72±26 mmHg; uric acid 6.8±1.8 mg/dL; LDL 91±37.4 mg/dL; triglycerides 170±104.6 mg/dL; PTH 152±131 pg/ml, and albuminuria 1203±1814 mg/g. Diabetic retinopathy occurred in 50%, most of them in stage G5A3. About one-third of patients (31%) had Coronary Arterial Disease, mostly in stage E5A3. Stroke occurred in 9%, with the majority in stage G4A2. Amputations occurred in 7%, mostly in stage G5A3. COVID infection was reported in 5.9%. Additionally, 52% were on ACEi/ARB, and only 4.0% were on SGLT2 inhibitors. Despite the severity, only 18% of patients progressed to KRT. Regarding the phenotypic profile of these patients, we obtained a distribution of 78% in the classical phenotype and among the alternative phenotypes, we obtained 9.38% non-proteinuric or non-albuminuric DKD, 7.55% with albuminuria regression, and 5% rapid decliners.
More than half of the patients were elderly (>60 years) and were in more advanced stages of DKD. The presence of albuminuria determined a higher cardiovascular risk, regardless of the CKD-EPI value, emphasizing the importance of early albuminuria management. In patients with multiple comorbidities, in advanced stages of renal disease, and restricted to the use of ACEi, ARB, and SGLT2 inhibitors, the multidisciplinary team's involvement (nutritionist, psychologist, nursing and physical trainer) proved important for glycemic control with positive impact in the disease control. Reinforcing the importance of early referral to nephrologists among medical colleagues is crucial for providing comprehensive care, improving outcomes, and potentially slowing the progression of diabetic kidney disease while reducing the associated cardiovascular risks for affected patients.