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Acute tubular necrosis in patients with diabetes mellitus
L S Weisberg1, R L Allgren, B R Kurnik
1Department of Medicine, Division of Nephrology, UMDNJ/Robert Wood Johnson Medical School, Cooper Health System, Camden, NJ 08103, USA. weisberg@umdnj.edu
Abstract:
We compared the clinical outcomes of patients with (n = 71) and without (n = 185) diabetes mellitus enrolled into the placebo arm of a large, multicenter clinical trial of patients with acute tubular necrosis (ATN). Compared with the nondiabetic patients, diabetic patients were older (65.5 +/- 12.9 versus 60.7 +/- 18.0 years, P < 0. 05), had higher usual serum creatinine concentration (1.7 +/- 0.6 versus 1.4 +/- 0.5 mg/dL, P < 0.001), and had a higher prevalence of underlying hypertension, coronary artery disease, and congestive heart failure (all P < 0.007). By day 21 after enrollment, neither mortality nor dialysis-free survival was different between the groups. Length of stay for surviving patients, in both the intensive care unit and the hospital, were significantly shorter for the diabetics. Among acute comorbidities predicting mortality or the need for dialysis, sepsis was more prevalent among the nondiabetic patients (18% versus 35%, diabetics versus nondiabetics, P < 0.05). In conclusion, clinical outcomes for diabetic patients with ATN were no worse than for nondiabetic patients, despite their older age and worse underlying renal function. Patients with diabetes mellitus had more chronic cardiovascular disease but were less acutely ill. We speculate that cardiovascular disease is a risk factor for ATN in patients with diabetes mellitus. These results fail to implicate the increasing prevalence of diabetes mellitus in the persistently poor prognosis of patients with ATN.
Insights
Diabetic patients with acute tubular necrosis (ATN) showed similar mortality and dialysis-free survival compared to non-diabetics. Despite older age and poorer renal function, diabetics had shorter hospital stays, suggesting cardiovascular disease may be a risk factor for ATN.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Diabetes mellitus is a growing public health concern with potential impacts on kidney disease.
- Acute tubular necrosis (ATN) is a severe kidney injury with a significant mortality rate.
- The influence of diabetes on ATN outcomes is not well-established.
Purpose of the Study:
- To compare clinical outcomes of patients with and without diabetes mellitus in the placebo arm of an acute tubular necrosis (ATN) clinical trial.
- To investigate the impact of diabetes on mortality, dialysis-free survival, and length of hospital stay in ATN patients.
- To identify comorbidities associated with outcomes in diabetic versus non-diabetic ATN patients.
Main Methods:
- Retrospective analysis of patients from the placebo arm of a multicenter clinical trial for ATN.
- Comparison of clinical characteristics and outcomes between diabetic (n=71) and non-diabetic (n=185) patients.
- Statistical analysis to assess differences in mortality, dialysis-free survival, length of stay, and comorbidity prevalence.
Main Results:
- Diabetic patients were older and had higher baseline serum creatinine, hypertension, coronary artery disease, and congestive heart failure prevalence.
- No significant differences were observed in mortality or dialysis-free survival by day 21 between diabetic and non-diabetic groups.
- Surviving diabetic patients experienced significantly shorter intensive care unit and hospital stays.
- Sepsis was more prevalent in non-diabetic patients.
Conclusions:
- Clinical outcomes for diabetic patients with ATN are comparable to non-diabetic patients, despite demographic and comorbidity differences.
- Older age and poorer renal function in diabetics did not translate to worse ATN prognosis.
- Cardiovascular disease may be a contributing risk factor for ATN in diabetic individuals.
- The increasing prevalence of diabetes does not appear to explain the persistent poor prognosis in ATN patients.