title: Prognostic value of proteinuria and glomerular filtration rate on Taiwanese patients with diabetes mellitus and advanced chronic kidney disease: a single center experience.
abstract: BACKGROUND
  Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD.
  
  
  METHODS
  A total of 447 diabetic patients with advanced CKD, age of 18-80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score.
  
  
  RESULTS
  Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction.
  
  
  CONCLUSIONS
  Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.|Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA.
authors.forename: Ping-Min
authors.initials: PM
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Laboratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan. ckchiang@ntu.edu.tw.|Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan. ckchiang@ntu.edu.tw.|Department of Integrative Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. ckchiang@ntu.edu.tw.
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors
keywords: Chronic kidney disease; Diabetes mellitus; Proteinuria