Glycosuria and Renal Outcomes in Patients with Nondiabetic Advanced Chronic Kidney Disease

Sci Rep. 2016 Dec 23:6:39372. doi: 10.1038/srep39372.

Abstract

Sodium glucose cotransporter 2 inhibitors have shown a potential for renoprotection beyond blood glucose lowering. Glycosuria in nondiabetic patients with chronic kidney disease (CKD) is sometimes noted. Whether glycosuria in CKD implies a channelopathy or proximal tubulopathy is not known. The consequence of glycosuria in CKD is also not studied. We performed a cross-sectional study for the association between glycosuria and urine electrolyte excretion in 208 nondiabetic patients. Fractional excretion (FE) of glucose >4% was 3.4%, 6.3% and 62.5% in CKD stage 3, 4 and 5, respectively. These patients with glycosuria had higher FE sodium, FE potassium, FE uric acid, UPCR, and urine NGAL-creatinine ratio. We conducted a longitudinal study for the consequence of glycosuria, defined by dipstick, in 769 nondiabetic patients with stage 4-5 CKD. Glycosuria was associated with a decreased risk for end-stage renal disease (adjusted hazard ratio: 0.77; CI = 0.62-0.97; p = 0.024) and for rapid renal function decline (adjusted odds ratio: 0.63; CI = 0.43-0.95; p = 0.032); but glycosuria was not associated with all-cause mortality or cardiovascular events. The results were consistent in the propensity-score matched cohort. Glycosuria is associated with increased fractional excretion of electrolytes and is related to favorable renal outcomes in nondiabetic patients with stage 5 CKD.

MeSH terms

  • Creatinine / urine
  • Cross-Sectional Studies
  • Electrolytes / urine
  • Female
  • Glomerular Filtration Rate / physiology
  • Glycosuria / urine*
  • Humans
  • Kidney / physiopathology*
  • Kidney Failure, Chronic / urine
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / urine*
  • Sodium-Glucose Transporter 2 Inhibitors
  • Uric Acid / urine

Substances

  • Electrolytes
  • Sodium-Glucose Transporter 2 Inhibitors
  • Uric Acid
  • Creatinine