|
Title Dysglycemia during Treatment and Follow up of Glomerulonephritis: a retrospective cohort study |
|
Type Oral Presentation |
|
Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
|
Topic Chronic Kidney Disease: Glomerular, Tubulointerstitial and Inherited Kidney disorders |
|
Main Author Rui Zhi Ng 1 |
|
Presenting Author Rui Zhi Ng 1 |
|
Co-Author Daphne Su-Lyn Gardner2 Yok Mooi Chin1 Irene Yanjia Mok1 Jason Chon Jun Choo1 Cynthia Ciwei Lim1 |
|
Department / Institution / Country Renal Medicine / Singapore General Hospital / Singapore1 Endocrinology / Singapore General Hospital / Singapore2 |
|
Abstract Content: Introduction, Method, Result, Conclusion Aim: Glucocorticosteroid and calcineurin inhibitors are frequently used to treat glomerulonephritis, yet there is little real-world data on new-onset dysglycemia. We aimed to evaluate the development of pre-diabetes and diabetes during treatment of glomerulonephritis. Methods: Single-centre retrospective cohort study of 343 non-diabetic immunosuppressant-naive adults with newly-diagnosed glomerulonephritis. After excluding 114 without fasting glucose or HbA1c values within 6 months pre-biopsy or during follow up, clinical and treatment data for 229 individuals were retrieved from electronic medical records. New-onset diabetes was defined by fasting venous glucose ≥7 mmol/L for 2 or more readings, HbA1c ≥6.5%, or the requirement for glucose-lowering medications; pre-diabetes was defined as fasting glucose between ≥5.6 and ≤6.9 mmol/L or HbA1c 5.7 to 6.4%. Results: At baseline, pre-diabetes was present in 74 (32.3%) individuals. Median age was 49.6 (35.3, 62.6) years. Common glomerulonephritides were minimal change disease or focal segmental glomerulosclerosis (29.3%), IgA nephropathy (24.9%), membranous nephropathy (14.4%) and lupus nephritis (13.5%). Median eGFR was 52.9 (26.2, 90.6) ml/min/1.73 m2. Immunosuppressants included prednisolone [68.1%; peak daily dose 50 (30, 60) mg], methylprednisolone (13.1%), calcineurin inhibitor (15.3%), mycophenolate (25.3%), cyclophosphamide (14.4%) and hydroxychloroquine (14.8%). During follow up [34.0 (23.3, 47.5) months], 29 (12.7%) had incident diabetes, 58 (25.3%) had new-onset pre-diabetes i.e. 38% had incident dysglycaemia; 35 (15.3%) had persistent pre-diabetes. Those treated with immunosuppressants were twice as likely to develop diabetes compared to those without (14.5% versus 7.8%, p=0.17). Older age (OR 1.02, 95% CI 1.01- 1.05), greater proteinuria (1.08, 1.01- 1.16), impaired fasting glycaemia (3.01, 1.36-6.66) and use of methylprednisolone (3.83, 1.54-9.50) and cyclophosphamide (3.30, 1.35-8.07) were associated with incident diabetes. Conclusion Dysglycaemia was common among non-diabetic immunosuppressant-naive adults treated for glomerulonephritis and immunosuppressant use was associated with new-onset diabetes. Screening for dysglycaemia prior to, and following immunosuppressant initiation, should be performed. |