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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Hematuria and Renal Outcomes in Patients With Diabetic Chronic KidneyDisease
Hugo You-Hsien Lin1, Sheng-Wen Niu2, I-Ching Kuo2
1Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Physiology and Biophysics, University of California at Irvine, Irvine,California; UC Irvine Diabetes Center, University of California at Irvine, Irvine,California.
Insights
Hematuria in diabetic chronic kidney disease (CKD) may signal other kidney diseases and predicts a higher risk of end-stage renal disease, especially in early stages. This finding is crucial for managing diabetic kidney disease progression.
Area of Science:
- Nephrology
- Diabetology
- Renal Pathology
Background:
- Hematuria in diabetic chronic kidney disease (CKD) can indicate nondiabetic renal disease.
- Its prognostic value in diabetic CKD, despite associations with albuminuria in some studies, remains unclear.
- Hematuria is a known risk factor for end-stage renal disease (ESRD) in glomerulonephritis.
Purpose of the Study:
- To investigate factors associated with hematuria in patients with diabetic CKD.
- To determine the prognostic significance of hematuria in patients with diabetic CKD.
Main Methods:
- A cohort of 1958 patients with type 2 diabetes and CKD stages 1-5 was analyzed.
- A subgroup of 111 patients underwent renal biopsy to assess renal disease.
- Statistical analyses identified factors associated with hematuria and its impact on ESRD risk.
Main Results:
- Hematuria was present in 15.0% of patients and linked to younger age, lower eGFR, proteinuria, hypertension, and shorter diabetes duration.
- Hematuria significantly increased the risk of ESRD (HR 1.39), particularly in early CKD stages (1-3) or with low proteinuria.
- Hematuria was associated with a higher odds ratio for rapid renal progression (OR 1.81).
Conclusions:
- Hematuria is associated with nondiabetic renal disease in biopsied patients with diabetic CKD.
- Hematuria predicts an increased risk of ESRD in patients with early-stage diabetic CKD.
Background:
Hematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD.
Material And Methods:
We included 1958 patients with type 2 diabetes and CKD stages 1-5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease.
Results:
In the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10-1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1-3 or a urine protein-to-creatinine ratio of <1,500mg/g (P for interaction < 0.05). The odds ratio of hematuria for rapid renal progression was 1.81 (95% CI: 1.29-2.53, P < 0.001).
Conclusions:
Hematuria is associated with nondiabetic renal disease in biopsied patients with diabetic CKD and is associated with an increased risk of end-stage renal disease in patients with early diabetic CKD.
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