Frequence of diabetic nephropathy phenotypes in the Brazilian population and its relationship with cardiovascular disease

• Grant number: 22/04820-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: January 01, 2023
• End date: December 31, 2023
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Andrei Carvalho Sposito
• Grantee: Luísa Moreira de Souza
• Host Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil

Abstract

In patients with type 2 diabetes (T2DM), declining glomerular filtration rate (GFR) and progression of proteinuria are defining elements of diabetic nephropathy (DN). In relation to patients with DM2 without renal involvement, individuals with DN have a mortality rate up to 2 times higher, and an increased risk up to 5 times of developing chronic kidney disease requiring renal replacement therapy. Patients with DN can be classified into clinical phenotypes, according to the presence of proteinuria and the estimated values of GFR, which were related in previous studies differently to the progression of atherosclerotic cardiovascular disease (ACVD). To date, there are no data in the Brazilian population on the prevalence of DN phenotypes, nor on the relationship of each DN phenotype with ACVD. methods. Observational, cross-sectional study, based on data from the Brazilian Diabetes Study (BDS), a prospective cohort initiated in 2016, which enrolled patients aged over 30 years, of both sexes, diagnosed with DM2. BDS participants who performed, at the time of enrollment, collection of blood and urine samples intended for the quantification of serum creatinine and albuminuria, respectively, will be recalled to repeat these tests. The difference between the two collections in the estimated GFR will be annualized for comparison. Albuminuria will be classified as microalbuminuria (30-300mg/g) and macroalbuminuria (>300mg/g). Based on these data, participants will be classified according to the phenotype of diabetic nephropathy as: (i) classic form, when annualized decline between 1 and 5ml/min/m2 and the presence of albuminuria is verified; (ii) regressors, in patients who presented albuminuria in the initial evaluation, but not in the last evaluation, or when they regressed from macro- to microalbuminuria; (iii) rapid decliners, when the annualized rate of decline in GFR is greater than 5ml/mi/m2; (iv) non-proteinuric, in those with reduced GFR in the absence of albuminuria. The prevalence of ACVD, defined by the presence of carotid plaque, common carotid artery intima-media thickness greater than the 75th percentile for age and gender, or coronary calcium score greater than 0 Agatston will be compared between groups.