Kidney Res Clin Pract > Volume 39(2); 2020 > Article |
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Conflicts of interest
Jason CJ Choo has served on Advisory Boards for Novartis and Pfizer with donation of honorarium to Singapore General Hospital to support research and education. The other authors have no conflicts of interest to declare.
Authors’ contributions
Cynthia Ciwei Lim, Daphne Gardner, and Jason CJ Choo conceptualised the study and study design. Yok Mooi Chin and Cynthia Ciwei Lim collected data. Cynthia Ciwei Lim performed statistical analysis. Cynthia Ciwei Lim, Jason CJ Choo, and Daphne Gardner interpreted data. Cynthia Ciwei Lim, Rui Zhi Ng, and Hui Zhuan Tan prepared the manuscript. All authors provided critical intellectual input to the work and reviewed the final manuscript.
Minimal change disease or FSGS | Immunoglobulin A nephropathy | Membranous nephropathy | Lupus nephritisb | |
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Number of patients | 67 | 57 | 33 | 31 |
Proportion of cohort (%) | 29.3 | 24.9 | 14.4 | 13.5 |
Immunosuppressant | ||||
Prednisolone | 45 (67.2) | 33 (57.9) | 23 (69.7) | 29 (93.5) |
Methylprednisolone | 1 (1.5) | 2 (3.5) | 0 (0.0) | 17 (54.8) |
Calcineurin inhibitor | 14 (20.9) | 6 (10.5) | 7 (21.2) | 2 (6.5) |
Mycophenolate mofetil or sodium | 7 (10.4) | 11 (19.3) | 7 (21.2) | 27 (87.1) |
Cyclophosphamide | 2 (3.0) | 1 (1.8) | 8 (24.2) | 7 (22.6) |
aThe four most frequent biopsy diagnoses among the 229 immunosuppressant-naïve non-diabetic adults are shown above, while etiologies including infection-associated glomerulonephritis and ANCA-associated vasculitis constituted the remaining 17.9%. bThe majority of patients with lupus nephritis also received hydroxychloroquine and only 1 received rituximab; none of the other 3 glomerulonephritide patients were treated with rituximab.
New-onset diabetesa | P value | New-onset pre-diabetesb | P value | |||
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No (n = 200) | Yes (n = 29) | No (n = 84)c | Yes (n = 58) | |||
Age (yr) | 48.6 (34.7-61.8) | 57.6 (43.5-67.0) | 0.03 | 46.4 (33.4-58.4) | 49.1 (33.2-65.0) | 0.37 |
Male | 89 (44.5) | 14 (48.3) | 0.70 | 31 (36.9) | 26 (44.8) | 0.34 |
Hypertension | 116 (58.0) | 17 (58.6) | 0.95 | 48 (57.1) | 29 (50.0) | 0.40 |
Systolic BP (mmHg) | 129 (116-140) | 134 (120-140) | 0.09 | 125 (114-140) | 124 (110-140) | 0.74 |
Diastolic BP (mmHg) | 70 (67-80) | 74 (68-82) | 0.42 | 71 (62-80) | 70 (63-80) | 0.19 |
Dyslipidemia | 54 (27.0) | 12 (41.1) | 0.11 | 22 (26.2) | 16 (27.6) | 0.85 |
Serum creatinine (mg/dL) | 1.30 (0.85-2.50) | 1.57 (1.11-2.50) | 0.18 | 1.11 (0.75-1.96) | 1.18 (0.84-1.97) | 0.92 |
eGFR < 60 (mL/min/1.73 m2) | 112 (56.0) | 21 (72.4) | 0.09 | 42 (50.0) | 32 (55.2) | 0.54 |
Urine protein-to-creatinine ratio (g/g) | 4.3 (2.0-8.4) | 6.9 (3.0-10.2) | 0.05 | 4.2 (2.0-8.2) | 5.7 (2.1-9.3) | 0.32 |
Fasting glucose at baseline (mg/dL) | 92 (85-99) | 99 (92-104) | 0.008 | 86 (81-92) | 90 (85-95) | 0.09 |
HbA1c at baseline (%) | 5.4 (5.1-5.7) | 5.6 (5.0-5.9) | 0.23 | 5.2 (4.9-5.4) | 5.2 (4.9-5.5) | 0.56 |
Pre-diabetes at baseline | 58 (29.0) | 16 (55.2) | 0.005 | - | - | - |
Triglyceride (mmol/L) | 1.7 (1.1-2.4) | 1.9 (1.3-2.4) | 0.23 | 1.6 (0.9-2.2) | 1.7 (1.1-2.5) | 0.43 |
LDL-C (mmol/L) | 3.9 (2.8-6.4) | 4.4 (2.8-5.9) | 0.69 | 3.8 (2.6-5.8) | 4.2 (3.4-4.8) | 0.18 |
HDL-C (mmol/L) | 1.3 (1.1-1.8) | 1.2 (1.0-1.4) | 0.06 | 1.4 (1.1-1.8) | 1.3 (1.1-1.9) | 0.61 |
Triglyceride/HDL-C ratio | 1.3 (0.7-1.9) | 1.6 (1.1-2.4) | 0.03 | 1.0 (0.6-1.7) | 1.2 (0.7-1.9) | 0.32 |
Prednisolone | 133 (66.5) | 23 (79.3) | 0.16 | 56 (66.7) | 43 (74.1) | 0.34 |
Prednisolone peak daily dose (mg per day) | 50 (30-60) | 40 (30-60) | 0.38 | 42 (30-60) | 50 (30-60) | 0.46 |
Methylprednisolone | 21 (10.5) | 9 (31.0) | 0.006 | 7 (8.3) | 6 (10.3) | 0.68 |
Calcineurin inhibitor | 29 (14.5) | 6 (20.7) | 0.41 | 17 (20.2) | 8 (13.8) | 0.32 |
Mycophenolate mofetil or sodium | 50 (25.0) | 8 (27.6) | 0.76 | 21 (25.0) | 20 (34.5) | 0.22 |
Categorical variables are expressed as number (%) and compared using chi-square or Fisher’s exact test as appropriate. Continuous variables are expressed as median (interquartile range) and compared using the Mann-Whitney U test.
BP, blood pressure; CKD EPI, Chronic Kidney Disease Epidemiology Collaboration; eGFR, estimated glomerular filtration rate calculated using the CKD EPI formula; HbA1c, glycated hemoglobin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
aDiabetes was present when fasting venous glucose ≥ 126 mg/dL for 2 or more readings, HbA1c was ≥ 6.5%, or if the patient required anti-diabetic medications during follow-up. bAnalysis for new-onset pre-diabetes after excluding patients with baseline pre-diabetes and those who developed new-onset diabetes. cPatients who did not develop new onset-prediabetes were normoglycemic at baseline and remained normoglycemic during treatment and follow-up.
Baseline pre-diabetes | Immunosuppressant treatment | Number of patients | New-onset diabetes mellitus, n (%) | Odds ratio (95% confidence interval)a | P value |
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No | No | 40 | 2 (5.0) | 1.00 (reference) | - |
No | Yes | 115 | 11 (9.6) | 2.01 (0.42-9.48) | 0.38 |
Yes | No | 24 | 3 (12.5) | 2.71 (0.42-17.55) | 0.29 |
Yes | Yes | 50 | 13 (26.0) | 6.67 (1.41-31.64) | 0.02 |