Epidemiological and Metabolic Aspects and Risk Factors of Chronic Kidney Disease in Comorbid Pathology of Type 2 Diabetes Mellitus and Primary Hypothyroidism

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Abstract

INTRODUCTION: The increasing number of patients with diabetes mellitus (DM) and chronic kidney disease (CKD) is one of the most pressing problems of modern medicine. In comorbid pathology — a combination of type 2 DM and thyroid hypofunction — the negative effect of hypothyroidism on carbohydrate metabolism, lipid metabolism, endothelial function, and glomerular filtration rate (GFR) is a risk factor for the formation and progression of diabetic nephropathy and CKD and requires further study.

AIM: To identify risk factors and epidemiological peculiarities of CKD in type 2 DM in combination with thyroid hypofunction and to determine the possibility of using cystatin C levels for the evaluation of the kidney function in this pathology.

MATERIALS AND METHODS: The prospective study involved 203 patients with type 2 DM undergoing inpatient treatment in the endocrinology department of the Ryazan Regional Clinical Hospital: group 1 (n = 76), type 2 DM combined with the primary hypothyroidism, and group 2 (n = 127), type 2 DM without thyroid pathology. Carbohydrate, lipid metabolism, albuminuria (AU), thyroid hormone spectrum, adipokines (leptin, plasminogen activator inhibitor-1, interleukin-6, and tumor necrosis factor-α) were analyzed. The GFR was calculated using the CKD-EPI formula based on the levels of creatinine and cystatin C. Arterial pressure daily monitoring (APDM) was conducted, and intra-abdominal fat thickness was evaluated by ultrasonography.

RESULTS: The incidence of kidney pathology in patients with type 2 DM was 52.22%. In group 1, there was a significant increase in the prevalence of CKD (64.47%, p = 0.006) and of normoalbuminuric CKD (NAU-CKD, 32.89%; p = 0.010). The risk of CKD development in patients with concomitant PH was more than twice that in patients without thyroid pathology with an odds ratio of 2.229 (95% confidence interval (CI) 1.241–4.003) and that for NAU-CKD was 2.474 (95% CI 1.267–4.833). Significant impairment of several metabolic parameters and individual APDM parameters was revealed in group 1 in comparison with group 2. The dependence of AU and GFR on the body mass index and of AU on the intra-abdominal fat thickness was noted. A negative relationship between GFR and leptin was revealed; in group 1, a correlation of interleukin-6 and thyrotropic hormone was found (r = 0.809, p = 0.001). With concomitant PH, cystatin C values were lower, and the GFR (CKD-EPI-cys) was reliably higher.

CONCLUSION: Hypothyroidism is a risk factor for CKD development including NAU-CKD in type 2 DM. Obesity and hormonal activities of the intra-abdominal fatty tissue facilitate AU progression and GFR reduction. The use of cystatin C as a marker of the filtration function of the kidney in patients with hypothyroidism may lead to the underestimation of kidney function; thus, further investigation is required.

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About the authors

Svetlana V. Berstneva

Ryazan State Medical University

Author for correspondence.
Email: berst.ru@mail.ru
ORCID iD: 0000-0002-3141-4199
SPIN-code: 6722-3203

MD, Cand. Sci. (Med.), PhD, Associate Professor, Associate Professor of the Department of Faculty Therapy with a Therapy FAPE Course

Russian Federation, Ryazan

Oleg M. Uryas’yev

Ryazan State Medical University

Email: uryasev08@yandex.ru
ORCID iD: 0000-0001-8693-4696
SPIN-code: 7903-4609
ResearcherId: S-6270-2016

MD, Dr. Sci. (Med.), PhD, Professor, Head of the Department of Faculty Therapy with a Therapy FAPE Course

Russian Federation, Ryazan

Inessa I. Dubinina

Ryazan State Medical University

Email: inessa.dubinina@mail.ru
ORCID iD: 0000-0001-6726-1756

MD, Dr. Sci. (Med.), PhD, Professor, Professor of the Department of Faculty Therapy with a Therapy FAPE Course

Russian Federation, Ryazan

Aleksandr A. Nikiforov

Ryazan State Medical University

Email: a.nikiforov@rzgmu.ru
ORCID iD: 0000-0002-7364-7687
SPIN-code: 8366-5282

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Ryazan

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Supplementary files

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2. Fig. 1. Incidence of renal pathology in patients with type 2 diabetes mellitus with and without primary hypothyroidism.

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3. Fig. 2. Incidence of anemia in patients with type 2 diabetes mellitus with and without primary hypothyroidism and chronic kidney disease. Note: * р < 0.05, comparison with the group of type 2 diabetes mellitus and group with type 2 diabetes mellitus in combination with primary hypothyroidism.

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4. Fig. 3. Hemoglobin level in patients with diabetes mellitus and chronic kidney disease (stages C1–C3b).

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5. Fig. 4. Parameters of cystatin C in the groups of patients with type 2 diabetes mellitus, primary hypothyroidism, combination of type 2 diabetes mellitus and primary hypothyroidism, and control group. Note: * p < 0.05, comparison with the control group; # p < 0.05, comparison with the type 2 diabetes mellitus group.

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