Evaluation of Renal Impairment in Patients with Diabetic Kidney Disease by Integrated Chinese and Western Medicine

Objective:To investigate the factors related to renal impairment in patients with diabetic kidney disease(DKD)from the perspective of integrated Chinese and Western medicine.Methods:Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included.According to Kidney Disease Improving Global Outcomes(KDIGO)staging guidelines,patients were divided into a chronic kidney disease(CKD)1-3 group and a CKD 4-5 group.Clinical data were collected,and logistic regression was used to analyze the factors related to different CKD stages in DKD patients.Results:Demographically,male was a factor related to increased CKD staging in patients with DKD(OR=3.100,P=0.002).In clinical characteristics,course of diabetes>60 months(OR=3.562,P=0.010),anemia(OR=4.176,P<0.001),hyperuricemia(OR=3.352,P<0.001),massive albuminuria(OR=4.058,P=0.002),atherosclerosis(OR=2.153,P=0.007)and blood deficiency syndrome(OR=1.945,P=0.020)were factors related to increased CKD staging in patients with DKD.Conclusion:Male,course of diabetes>60 months,anemia,hyperuricemia,massive proteinuria,atherosclerosis,and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD.(Registration No.NCT03865914).

Influence of peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients on continuous ambulatory peritoneal dialysis

Background Extra glucose load in peritoneal dialysis is an important cause of newly-occurred diabetic mellitus, which initiates insulin treatment in some of the dialytic patients. The purpose of this study was to discuss the influence of the peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients who are on continuous ambulatory peritoneal dialysis （CAPD）. Methods One hundred and forty-five patients with total KTN per week over 2.0 were recruited, including 60 males and 85 females. Fasting blood glucose （FBG）, creatinine, blood urea nitrogen （BUN）, blood albumin, blood lipid profile and blood C-reactive protein （CRP） were analyzed at the beginning of the peritoneal dialysis and after 12 months. A peritoneal equilibration test （PET） was carried out at the 3rd month of CAPD, and meantime residual renal function, peritoneal solute clearance rate, ultrafiltration volume and urine volume were also evaluated. Results Twenty-one cases were identified as a low transfer group （L）, 32 cases as a low average transfer group （LA）, 58 cases as a high average transfer group （HA） and 34 cases as a high transfer group （H）. At the end of the 12th month, 83 cases had elevated FBG. Through stepwise multiple regression analysis we found the FBG level in these patients was positively related to glucose load and CRP, and negatively related to glucose absorption in the peritoneum （D/D0） and blood albumin （P 〈0.05）. Kaplan-Meier analysis during a 48-month follow-up found the morbidity of hyperglycemia to be 17/34 cases （50.1%） in the high transfer group, 20/58 cases （34.5%） in the high average transfer group, 11/32 cases （34.3%） in the low average transfer group, and 1/21 cases （5.4%） in the low transfer group. Conclusions Patients with high peritoneal transfer capacity might have the highest morbidity from hyperglycemia among patients with these four different peritoneal transfer status. Glucose load, baseline CRP and FBG level before peritoneal dialysis, and D/D0 can efficiently predict hyperglycemia in CAPD patients.