Factors related to nephrotic-range proteinuria in late-stage chronic kidney disease patients with diabetes mellitus.
OBJECTIVE
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.
Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, No. 162, Chenggong 1st Rd., LingYa District, Kaohsiung, 802, Taiwan, ROC.
Yit-Sheung
YS
Yap
Hung-Yi
HY
Chuang
Wen-Che
WC
Chi
Cheng-Hao
CH
Lin
Yi-Wen
YW
Wu
Pai-Chun
PC
Chang
Yi-Chun
YC
Liu
D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology / Q000652:urine*; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000652:urine; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D011507:Proteinuria / Q000097:blood / Q000652:urine*; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology / Q000652:urine*
D010758:Phosphorus; D003404:Creatinine