Prediabetes in Children and Adults with Glomerular Disease

Glomerular disease (GD) and diabetic nephropathy are both leading causes of end-stage kidney disease (ESKD) in the USA. Much is known about each individually, but less of any interactions between the two. There is emerging evidence that factors specific to GD, such as immunosuppression, may increase the risk of diabetes, which in turn could compound glomerular filtration rate decline through the mechanisms of diabetic nephropathy. Understanding the epidemiology of prediabetes and diabetes in GD patients may inform improved screening and prevention practices in this population and may lead to strategies that mitigate progression to ESKD. The aim of this study was to delineate risk factors for prediabetes in GD.

Data were extracted from University of Michigan and Kidney Research Network electronic health record registry with patients classified by age at GD at diagnosis or first nephrology appointment (child [age <18 y, n = 406] and adult [≥18 y, n = 339]). A Cox proportional hazards model was calculated using prediabetes after kidney disease onset as the outcome, adjusted for age, sex, race, weight, hypertension, and defined relevant drug prescriptions. A subgroup analysis was performed to track the progression from prediabetes to diabetes.

A total of 148 patients (19.9% of cohort) developed prediabetes in study follow-up. Adult GD patients were more likely than pediatric GD patients to progress (HR: 1.73 [95% CI: 1.19-2.50]), as were patients with uncontrolled hypertension (HR: 9.61 [95% CI: 3.02-30.61]) and controlled hypertension (HR: 6.50 [95% CI: 1.91-22.18]). The use of beta-blockers, statins, or diuretics was also associated with higher prediabetes risk (HR: 2.87 [95% CI: 1.98-4.17]).

Adult age, worsening control of hypertension, and certain medications were associated with increased prediabetes risk in preexisting GD. More data, in particular prospective data, are needed to refine risk relationships and incidence data.