Endocrine Abstracts

Background: Poor glycemic control in patients with diabetes mellitus(DM) is a well-documented responsible factor for microvascular complications, especially eye and kidney damage. The onset of chronic kidney disease(CKD) marks a serious turning point in the clinical history of DM in terms of cardiovascular prognosis. Our study aims to assess the cardiovascular risk(CVR) in diabetic patients with CKD.

Method: We conducted a retrospective descriptive study on 88 type 2 diabetic patients with CKD, admitted during 2019-2020 to the Endocrinology-Diabetology Department of Hedi Chaker University Hospital, Sfax, Tunisia.

Results: The mean age was 68.7±10.9 years with a male predominance(52.3%). Active smokers represented 12.5%. We noted a family history of CKD and early cardiovascular events in 12.5% and 5.7% of cases, respectively. The mean duration of the evolution of diabetes was 13±9 years. We highlighted a glycemic imbalance in 80.2% of patients with a mean fasting plasma glucose of 2.78±1.5g/l and an average HbA1C level of 9.68±2.5%. Dyslipidemia and hypertension were encountered in 94% and 86.4% of cases, respectively. Obesity affected 35.7% of the patients with a mean BMI of 28,53 ± 5.11 kg/m². Macroangiopathy was documented in 29.5%, mainly ischemic heart disease (19.3%) and stroke (9.1%). Diabetic retinopathy was diagnosed in 53.5%. The mean glomerular filtration rate(GFR) was 32.2±13.81 mL/min/1.73 m². Most patients were Stage 3 CKD (56.8%) whereas 30.5% were stage 4 and 12.5% stage 5. Hemodialysis was undergone for 7.9%. Albuminuria was positive in 52.2% with mean proteinuria of 1.46±2.4 g/24 h. According to the European Society of Cardiology 2021 CVR assessment, all patients are among the very high CVR range.

Discussion: Diabetic nephropathy (DN) is the first leading cause of CKD in the world. Chronic hyperglycemia is responsible for the vascular damage and progression of CKD to terminal-stage and recourse to hemodialysis. In addition to traditional CVR factors, GFR impairment and albuminuria are independent markers of CVR and overall morbidity in diabetic patients. This risk is proportional to the severity of CKD and would be maximal in hemodialysis patients. We recommend screening annually for DN using a urine dipstick test and serum creatinine measurement. Achieving the best glycemic control (A1c<7%), treating high blood pressure (<130/80 mmHg or <125/75 mmHg if proteinuria >1.0 g/24 h and increased serum creatinine), using nephroprotective renin-angiotensin-aldosterone system blockers, and treating dyslipidemia (LDL-cholesterol<0.55 g/l) are effective measures for preventing the development of microalbuminuria, delaying the progression to more advanced stages of CKD and reducing the overall cardiovascular mortality in diabetic patients.