Endocrine Abstracts

Introduction: Chronic kidney disease (CKD) is one of the leading causes ofdisability and mortality in patients with diabetes mellitus. Existence of specific phenotypes of diabetic kidney disease (DKD) is established nowadays. The prevalence of the classic albuminuric phenotype has decreased by 24% over the past decade (NHANES).

The purpose of our work was to investigate the phenotypic features of DKD depending on the type of diabetes.

Materials and methods: A comprehensive survey of 1576 patients with diabetes was analyzed, 447 of which were of type 1 diabetes mellitus (T1DM), 1041 were of type 2 diabetes mellitus (T2DM) and 88 patients were with latent autoimmune diabetes in adult (LADA). We studied the frequency and features of the course of CKD, as well as the prevalence of phenotypic forms of DKD: classical albuminuria, nonalbuminuric renal dysfunction and progressive decrease in renal function. Glomerular filtration rate (GFR) was evaluated using the CKD-ERI formula, albuminuria, albumin-creatinine ratio (AKR), and kidney ultrasound were analyzed.

Results: The incidence of CKD in T1DM was 38% (203 patients), 23% (242 patients) in T2DM and 30% (34 patients) in LADA. In T1DM, CKD stage was recorded with the following frequency: G1 – 24%, G2 – 58%, G3a – 16%, G3b – 1%; by albuminuria category: A1 – 21%, A2 – 79%. In T2DM, stage G1 occurred in 8% of patients, G2 in 48%, G3a in 26%, Gb in 14%, G4 in 4% of patients; albuminuria in stage A1 was reported in 29% of patients, and A2 in 71%. In turn, with LADA G1 stage CKD occurred in 17% of patients, G2 – in 63%, G3a – in 16%, G3b – in 3%, G 4 – in 1%; albuminuria in stage A1 was reported in 37% of patients, and A2 in 63%. Classical albuminuric phenotype was reported in 21% of patients with T1DM, 29% of patients with T2DM, and 25% of patients with LADA. The proportion of patients with nonalbuminuric renal dysfunction was 60% for T1DM, 43% for T2DM, and 53% for LADA. In turn, progressive kidney damage was detected in 19% of T1DM, 28% of T2DM, and 22% of LADA cases.

Conclusion: Nonalbuminuric DKD was observed in 60% of cases of T1DM, in T2DM – 43%, while LADA was diagnosed in 53% of cases. The incidence of classic albuminuric phenotype is higher in T2DM, and progressive kidney damage is 1.5 times higher than in patients with T1DM and LADA.