A-191 RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF DIABETIC NEPHROPATHY IN PATIENTS WITH DIABETES

Abstract

Diabetic nephropathy is a complication of type 2 diabetes mellitus associated with reduced glomerular filtration rate and increased albuminuria. The Kidney Disease, Improving Global Outcomes (KDIGO) 2012 classification integrates estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) to stratify renal risk. This study analyzed clinical and laboratory parameters according to KDIGO risk categories in patients with type 2 diabetes mellitus. A cross-sectional study was realized including 213 patients with previously diagnosed type 2 diabetes mellitus from Hospital (Centro de Salud IMSS-Bienestar Alameda, Chilpancingo de los Bravo Guerrero, México), 137 women and 76 men, anthropometric data were obtained, and blood and urine samples were collected. Laboratory tests included blood chemistry, lipid profile, atherogenic index, eGFR rate, glycated hemoglobin (HbA1c), complete red and white blood cell count, urine creatinine and albumin quantification, and urinalysis. Patients were classified according to KDIGO 2012 risk categories and statistical analysis included Mann-Whitney U test, Student’s t-test, and Chi-square test. For analytical purposes, KDIGO risk categories were grouped into two broader strata: low-to-moderate risk and high-to-very-high risk, according to the KDIGO 2012 classification system, to facilitate comparative analysis between lower and higher renal risk profiles. Among the total population, 30.20% were classified in high and very high KDIGO risk categories. Significant differences were observed between KDIGO groups in renal function markers. Patients in the high-to-very-high KDIGO category showed higher creatinine levels (1.39 vs 0.93 mg/dL, p = 0.0001), higher urea (47.82 vs 35.41 mg/dL, and higher ACR (417.18 vs 80.26 mg/g, p = 0.025), while eGFR was significantly lower (51.02 vs 78.75 mL/min/1.73 m², p = 0.0001). Proteinuria was the most frequent alteration in urinalysis, identified in 65.73% of patients (p = 0.003). Regarding glycemic parameters, median fasting glucose was 157.11 mg/dL and median HbA1c was 7.56%; however, no significant differences were observed between KDIGO categories (glucose p = 0.361; HbA1c p = 0.553). Regarding hematological parameters, no significant differences were observed between KDIGO risk groups for most variables. However, red blood cell count (4.62 vs 4.50 ×106/µL, p = 0.001), hemoglobin (14.02 vs 13.27 g/dL, p = 0.003), and hematocrit (40.7% vs 38.47%, p = 0.002) were higher in the high-to-very-high risk group. According to the KDIGO 2012 classification, 30.20% of patients were classified in the high and very high risk categories. Renal biomarkers, including creatinine, urea, ACR, eGFR, and proteinuria, showed significant differences across risk groups and were biologically consistent declining renal function across increasing KDIGO risk categories. Glycemic parameters were not significantly associated with KDIGO risk stratification.