title: Effects of various stages of nephropathy on wound healing in patients with diabetes: an observational cohort study encompassing 731 diabetics.
abstract: OBJECTIVE
  In diabetics genetic predisposition, poor glycemic control and arterial hypertension contribute to nephropathy development in patients affected by diabetes mellitus. We set up the hypothesis that diabetic nephropathy and incisional hernia formation may have in common alterations of collagen composition and tested whether the occurrence of diabetic nephropathy coincides with wound healing disturbance (incisional herniation) or connective tissue diseases (inguinal herniation, umbilical herniation, aortic aneurysm, varicose veins, disc herniation).
  
  
  METHODS
  A questionnaire on surgical procedures, wound healing and connective tissue disorders was performed with 731 diabetics. Furthermore, test results for kidney function and damage (creatinine clearance, proteinuria) and blood sugar control (HbA1c) were recorded. Correlations between aforementioned connective tissue diseases and "advanced" diabetic nephropathy were calculated. "Advanced" diabetic nephropathy was assumed in patients with macroproteinuria, CKD stage 5 and/or end-stage renal disease. All diabetics with CKD stages 1 and 2 without proteinuria were included in the "control" group. A subgroup analysis on incisional hernia formation coinciding with diabetic nephropathy was performed in patients with previously performed abdominal surgery.
  
  
  RESULTS
  In patients with advanced nephropathy, some diseases with connective tissue alterations, such as inguinal herniation, aortic aneurysms and varicose veins, did not occur more frequently than in patients without nephropathy. In diabetics with nephropathy, umbilical herniation (3 vs. 8.2 %, p = 0.04) and disc herniation rates (5.7 vs. 16.1 %, p = 0.002) were significantly lower. Subgroup analysis of patients with previously performed abdominal surgery (n = 381) revealed significantly higher incisional herniation rates when "advanced" diabetic nephropathy was present (16 % compared to 5.7 % without nephropathy, p = 0.016).
  
  
  CONCLUSIONS
  Our findings support the hypothesis that incisional hernia formation and diabetic nephropathy are positively correlated. Conversely, umbilical and disc herniation pathomechanisms are distinct, as these negatively correlate with the presence of advanced diabetic nephropathy.
authors.affiliation: Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. paula.holstiege@med.ovgu.de.
authors.forename: Paula
authors.initials: P
authors.lastname: Loewe
authors.affiliation: Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Stefanidis
authors.affiliation: Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mertens
authors.affiliation: Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Chatzikyrkou
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D001014:Aortic Aneurysm / Q000453:epidemiology; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006552:Hernia, Inguinal / Q000453:epidemiology; D006554:Hernia, Umbilical / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000453:epidemiology*; D007405:Intervertebral Disc Displacement / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014648:Varicose Veins / Q000453:epidemiology; D014945:Wound Healing
keywords: Chronic kidney disease; Connective tissue disease; Diabetic nephropathy; Incisional hernia; Risk factor