The Presence of Chronic Kidney Disease in Relation to Age and Duration of Diabetes Mellitus

IONELA MIHAELA VLADU1#, TIBERIU STEFANITA TENEA COJAN2*, ALIN DEMETRIAN3#, OANA MARIANA CRISTEA4#, CRISTINA GABRIELA ENE5, DIANA CLENCIU6 1University of Medicine and Pharmacy of Craiova, Department of Metabolism and Nutrition Diseases, Filantropia Clinical Hospital of Craiova, 1 Filantropiei Str., 200143, Craiova, Romania 2University of Medicine and Pharmacy of Craiova, Department of Surgery, CFR Hospital of Craiova, Stirbei-Voda Str., 200374,Craiova, Romania 3University of Medicine and Pharmacy of Craiova, Department of Thoracic Surgery, County Hospital Craiova, 2-4 Petru Rares Str.Craiova, 200349 Romania 4University of Medicine and Pharmacy of Craiova, Department of Microbiology, County Hospital Craiova, 2-4 Petru Rares Str.Craiova, 200349 Romania 5University of Medicine and Pharmacy of Craiova, Pharmacology Department, County Hospital of Craiova, 2-4 Petru Rares Str.,200349, Craiova, Romania 6University of Medicine and Pharmacy of Craiova, Department of Metabolism and Nutrition Diseases, Filantropia Clinical Hospital of Craiova, 1 Filantropiei Str., 200143, Craiova, Romania

Chronic kidney disease (CKD) affects about 10-13% of the general population with a small proportion in the terminal renal disease stage requiring renal replacement therapy or renal transplantation. CKD is the new cause of mortality in the US. CKD's prevalence increases with age. Diabetes mellitus is responsible for 50% of cases of chronic kidney disease being the most common cause [1]. Diabetic CKD is the most common cause of chronic renal failure involving renal replacement therapy worldwide, especially in the type 2 diabetes patients [2][3][4]. Diabetes mellitus (DM) is responsible for 30-40% of the causes of end-stage renal disease in the United States [5][6][7][8][9][10][11]. In the past 30 years, the rate of type 1 DM requiring renal replacement therapy declined considerably due to improved treatment strategies for DM and artherial hypertension [12][13][14][15][16].
Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro and macro-vascular complications. DM is the most frequent cause of chronic kidney disease (CKD). The diabetic chronic kidney disease (CKD) is a clinical syndrome characterized by persistent albuminuria (albumin/creatinine ratio in the spontaneous urine ≥ 30mg/g) and/or a sustained decline of the estimated glomerular filtration rate (eGFR) below 60 mL/min/1.72m 2 [17][18][19][20]. If at least one of these values is still maintained within these abnormal limits after 3 months from the first measurement, the diagnosis of diabetic CKD may be established [21][22][23][24][25][26].

Experimental part
The aim of the study The aim of this study was to assess the presence of chronic kidney disease in relation to age and duration of type 1 and type 2 diabetes mellitus.

Material and method
The study type is epidemiological, transversal, noninterventional, with unselected patients. It was performed by analyzing 600 subjects divided into three groups, as follows: Lot 1 includes 200 patients with type 1 diabetes, Lot 2 includes 200 patients with type 2 diabetes and lot 3 (control) consisting of randomly recruited 200 individuals without diabetes.
The following laborator y blood counts were performed: serum creatinine, total cholesterol, HDLcholesterol, triglycerides, uric acid, serum hemoglobin; LDL-cholesterol was calculated with the Friedwald formula.
Recorded data were analyzed using the SPSS software 17.00 (IBM Corporation, Armonk, NY, USA). The methods used were: t-test, Mann-Whitney test, Chisquare test, simple binary logistic regression, multiparametric logistic regression and multiparametric logistic regression with stepwise covariate selection.

Results and discussions
We conducted a study on 600 subjects (289 women and 311 men) divided into 3 batches.
We calculated the coefficient of contingency Phi and Cramer 's V, obtaining the value of 0.412. There is a statistically significant difference between the three groups (p <0.0001) with respect to the presence of CKD, the highest percentage being seen in patients with type 2 DM, followed by patients with type 1 DM and a small percentage in the control group .
Depending on the estimated glomerular filtration rate, we have staged CKD in the 5 stages. Figures 3-5 highlight the presence of CKD for each group.
The age of patients with type 1 diabetes who have chronic kidney disease (CKD) was lower versus the age of patients with type 2 diabetes and CKD, but comparable between patients with type 2 diabetes and those without diabetes (control). This was proven by the Mann-Whitney U and Wilcoxon W statistical tests, showing significant differences between age of patients with type 2 diabetes with CKD and the age of patients with T1DM with CKD (p <0.001) between patients with diabetes type 1 with CKD those without diabetes (control) with CKD (p <0.001), but not significant between type 2 diabetes and CKD control group (p = 0.910) ( fig. 6, table 2).
The average age of developing CKD in type 1 diabetes was around 43.55 years; in T2DM the average age was We evaluated the presence of kidney disease in each of the three lots. Based on the KDIGO 2013 criteria, we identified patients diagnosed with CKD with the following variants: -patients with an estimated glomerular filtration rate (eGFR) < 60mL / min / 1.73mp and absent albuminuria -patients with an eGFR < 60mL / min / 1.73mp and present albuminuria -patients with an eGFR > 60mL / min / 1.73mp and present albuminuria In group 1, diabetic CKD in patients with type 1 DM, was found to be 44.5%; in group 2, in patients with type 2 DM, diabetic CKD was found to be 53.5% and in the control group 8% (fig. 2, yable 1).  Kruskal Wallis statistical test showed statistically significant differences between type 1 and type 2 diabetes and between T1DM and the control group (p <0.001), but not significant between T2DM and the control group (table 3). The age of patients at diagnosis of diabetes with CKD was statistically significant (p <0.001) lower in patients with type 1 diabetes than in those with type 2 diabetes. Applying the statistical Mann-Whitney U test and Wilcoxon W we found significant differences between age diagnosing diabetes in patients with type 1 diabetes compared with CKD aged patients with type 2 diabetes with CKD (p <0.001) (fig. 7).
The average duration of development of type 1 diabetes associated with CKD stood around 20 years, being statistically significant (p <0.001) higher compared to the duration of 8.5 years of development in patients with type 2 diabetes associated with CKD ( fig. 8, table 4). The Kruskal Wallis statistical test applied showed statistically significant differences between type 1 and type 2 diabetes mellitus (p <0.001).

Conclusions
Diabetic CKD prevalence increases with age and duration of diabetes. Age of occurrence of CKD is lower in patients with type 1 diabetes compared to those with type 2 and the general population. CKD incidence and prevalence increases with age. Old age seems to be a negative predictor for the occurrence of end stage of CKD.