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Int Urol Nephrol. 2013 Oct;45(5):1327-37. doi: 10.1007/s11255-013-0378-2. Epub 2013 Jan 26.

Factors related to nephrotic-range proteinuria in late-stage chronic kidney disease patients with diabetes mellitus.

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1
Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, No. 162, Chenggong 1st Rd., LingYa District, Kaohsiung, 802, Taiwan, ROC.

Abstract

PURPOSE:

Diabetic nephropathy and proteinuria are important risk factors for both end-stage renal disease and cardiovascular events. The present study aimed to identify the factors associated with nephrotic-range proteinuria in patients with advanced diabetic nephropathy.

METHODS:

This cross-sectional study enrolled 386 diabetic patients with chronic kidney disease (CKD) stages 3-5, from our outpatient Department of Nephrology. Urinary protein-to-creatinine ratio was recorded. Additionally, other laboratory parameters, body mass index, blood pressure, comorbidities, and medications were also reviewed.

RESULTS:

The mean age of the patients was 65.1 ± 11.6 years. Among patients with CKD stage 3 and 4, the odds ratio (OR) for nephrotic-range proteinuria in relation with systolic blood pressure significantly increased starting from 121 mmHg (OR 7.04 and 11.79 for systolic blood pressure of 121-140 and ≥141 mmHg, respectively, in comparison with systolic blood pressure below 121 mmHg). In addition, serum phosphorus ≥4.7 mg/dl was associated with significantly higher risk (OR 15.45) for severe proteinuria, compared with a phosphorus level ≤2.6 mg/dl. Finally, hypertriglyceridemia ≥241 mg/dl was also associated with higher OR for severe proteinuria, compared with a triglyceride level ≤200 mg/dl. Similar associations were found in patients with CKD stage 5.

CONCLUSIONS:

Higher systolic blood pressure, serum phosphorus, and triglyceride levels are associated with nephrotic-range proteinuria in patients with diabetic nephropathy and CKD stage 3-5. Further studies should clarify whether a reduction in serum phosphorus would lead to a decrease in proteinuria in these patients.

PMID:
23355027
DOI:
10.1007/s11255-013-0378-2
[Indexed for MEDLINE]
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