Frequency and characteristics of non-albuminuric diabetic kidney disease in diabetic patients

Introduction and Objective: Diabetic kidney disease may present as albuminuric or non-albuminuric. NADBH is defined as an eGFR of less than 60 ml/min/1.73 m² and albumin excretion of less than 30 mg/day in diabetic individuals, following the exclusion of other chronic kidney disease etiologies. This study sought to ascertain the prevalence and attributes of non-albuminuric diabetic kidney damage in individuals with diabetes. Materials and Methods: This prospective study covered diabetic patients who consecutively presented at the Internal Medicine and Endocrinology and Metabolic Diseases clinics of Manisa Celal Bayar University from 2023 to 2024. Following the application of exclusion criteria, data from a total of 1021 individuals with type 1 and type 2 diabetes mellitus were documented from outpatient clinic and service files. Due to the limited number of patients with type 1 diabetes mellitus, they were incorporated solely into the general statistics. Patients with Type 2 Diabetes Mellitus were initially categorized into four groups based on estimated Glomerular Filtration Rate (eGFR) and albuminuria for analysis. One hundred seventy-seven patients with a GFR of less than 60 ml/min/1.73 m² were categorized into two groups: albuminuric and non-albuminuric, followed by statistical analysis of these groups. Findings: In our analysis, 177 of 1,021 patients (17.3%) were identified as having diabetic renal disease. Of these patients, 82 (46.3%) were non-albuminuric, whereas 95 (53.7%) were albuminuric. The average age of the NADBH group was determined to be greater. The NADBH group predominantly got non-insulin anti-hyperglycemic pharmacotherapy, whereas the ABDH group primarily received insulin and IDT combination therapy. Metformin, ARB, diuretic, and anti-aggregant therapies were prevalent in the NADBH group, whereas ACE inhibitor and calcium channel blocker therapies were predominant in the ADBH group. The metabolic profile of the NADBH group was superior. The BMI, systolic blood pressure, and waist circumference were reduced; however, the disparity between the two groups was not statistically significant. The NADBH group exhibited superior kidney function test results. Conclusion: In the research we conducted, consistent with existing literature, almost fifty percent of individuals with diabetic kidney disease were identified as non-albuminuric. Consequently, eGFR must be incorporated into the screening for diabetic nephropathy with albuminuria. Extensive prospective follow-up studies with substantial participation are required for NADBH, which exhibits distinct characteristics from albuminuric patients for age, treatment modalities, comorbidities, complications, and laboratory evaluations. Keywords: Diabetes Mellitus, Diabetic Kidney Disease, Non-albuminuric Diabetic Kidney Disease