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Association of diabetes with failure to achieve complete remission of idiopathic membranous nephropathy

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Abstract

Purpose

The association of type 2 diabetes with proteinuria remission and renal function decline in patients with idiopathic membranous nephropathy (IMN) remains elusive. This study was designed to assess such association.

Methods

In this retrospective cohort study, we included 656 IMN patients treated with immunosuppressants or plus corticosteroids, of whom 72 were diagnosed as type 2 diabetes prior to or at diagnosis of IMN. Data on age, sex, body mass index, presence of hypertension and diabetes, laboratory tests, and therapeutic regimens were retrospectively retrieved from medical record. Cox regression was used to analyze risks of failure to achieve remission, relapse, and developing a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD) associated with baseline diabetes.

Results

The patients were followed for 36.6 (IQR 17.5–59.0) months, of whom 451 reached complete remission, 92 achieved partial remission, and 61 developed a ≥ 30% eGFR decline or ESRD. IMN relapse occurred in 30.6% of the 543 remitted patients. Baseline diabetes was associated with failure to achieve complete remission (HR 0.61, 95% CI 0.43–0.86, P = 0.005) in patients with IMN, independently of age, sex, hypertension, baseline serum albumin, urine protein levels, and eGFR, and therapeutic regimens. However, we failed to identify independent association between baseline diabetes and failure to achieve total remission (HR  0.85, 95% CI 0.63–1.1, P = 0.29), IMN relapse (OR 0.92, 95% CI 0.49–1.7, P = 0.80), or ≥ 30% decline in eGFR or ESRD (HR  1.4, 95% CI 0.78–2.7, P = 0.24) in patients with IMN.

Conclusions

Baseline diabetes may be independently associated with failure to achieve complete remission, but not with IMN relapse and renal function decline in IMN patients.

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Acknowledgements

The study was supported by the Education Foundation for Youth Teachers of the Peking Union Medical College Hospital (Grant number 2015zlgc0707) and Teaching Reform Project for Postgraduate Courses of Peking Union Medical College (Grant number 10023201800101).

Funding

The study was funded by the Education Foundation for Youth Teachers of the Peking Union Medical College Hospital (Grant number 2015zlgc0707) and Teaching Reform Project for Postgraduate Courses of Peking Union Medical College (Grant number 10023201800101). None of the sponsors participated in the design of study or in the collection, analysis, or interpretation of the data.

Author information

JC, HL, and HX had full access to all of the data and take responsibility for the data, data analyses and interpretation. JC and HL had the right to publish any or all data. All authors participated in the conduct of the research, and contributed to the manuscript for important intellectual content.

Correspondence to Jianfang Cai or Hang Li.

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The authors declare that they have no conflict of interest.

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This study was approved by the Institutional Review Board of the Peking Union Medical College Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Xie, H., Li, C., Wen, Y. et al. Association of diabetes with failure to achieve complete remission of idiopathic membranous nephropathy. Int Urol Nephrol 52, 337–342 (2020). https://doi.org/10.1007/s11255-019-02348-2

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Keywords

  • Type 2 diabetes
  • Non-diabetic kidney disease
  • Membranous nephropathy
  • Calcineurin inhibitors