MP232
METABOLIC PROFILE AND CARDIOVASCULAR RISK IN PATIENTS WITH GLOMERULAR DISEASE TREATED WITH IMMUNOSUPPRESSANTS Free

INTRODUCTION AND AIMS: Immunosuppressants (IS) are often required to treat glomerulonephritis (GN) to prevent subsequent chronic kidney disease and end-stage renal disease (ESRD). However, metabolic complications arising from IS therapy may also lead to undesirable outcomes such as cardiovascular disease (CVD). We compared the metabolic profiles of diabetics (DM) and non-diabetics who received IS therapy for glomerular disease and evaluated risk factors for CVD.

METHODS: This was a retrospective cohort study of adults with biopsy-proven GN diagnosed between 13^th January 2011 and 28^th July 2015. Patients <21 years and those who received IS prior to kidney biopsy were excluded. Demographic, comorbidity, clinical and pharmacotherapy data were retrieved from electronic medical records. Pre-biopsy fasting glucose, triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) within 6 months preceding kidney biopsy and peak values within 6 months after IS therapy were obtained. CVD was present if there was an admission for acute myocardial infarction, congestive cardiac failure, or if coronary angiogram found >50% stenosis in the coronary vessels.

RESULTS: We studied 285 patients [median age 49.3 (IQR 34.6, 62.6) years, male 44.6%]. Comorbidities included DM (14.4%), hypertension (46.3%) or hyperlipidemia (29.1%). Minimal change disease or focal segmental glomerulosclerosis (26.7%), IgA nephropathy (18.6%), lupus nephritis (17.9%) and membranous nephropathy (14.4%) were the common GN diagnoses. Median follow up was 28.5 (13.2, 51.4) months. Comparing diabetics and non-diabetics, patients with DM were older [55.9 (45.9, 66.3) vs. 47.1 (33.6, 62.1) years, p=0.003], had hypertension (78.0% vs. 41.0%, p<0.001) and dyslipidemia (63.4% vs. 23.4%, p<0.001). Patients with DM had higher baseline glucose [6.2 (5.4, 8.1) vs. 5.2 94.8, 5.8] mmol/L, p<0.001], lower LDL [3.29 (4.14, 2.26) vs. 4.04 (2.80, 6.52) mmol/L, p=0.02] and HDL [1.07 (0.88, 1.37) vs. 1.34 (1.10, 1.77) mmol/L, p=0.006] than those without DM. There was no difference in baseline serum creatinine [124 (84, 197) vs. 107 (73, 189) µmol/L, p=0.19]. Diabetics received lower prednisolone doses [30 (20, 50) vs. 50 (30, 60) mg/day, p=0.007] but more received cyclosporine (36.6% vs. 12.3%, p<0.001). After IS therapy, patients with DM had greater increase in fasting glucose [46.9% (3.2, 80.8) vs. 12.4% (0, 38.6), p=0.003] and TG [18.6% (-19.9, 53.2) vs. -8.9% (-40.9, 25.5), p=0.03] than non-diabetics. CVD occurred in 14 patients at 11.7 (4.2, 28.2) months after biopsy. Multivariate analysis (adjusting for age, gender, comorbidities, renal function, proteinuria and post-IS therapy levels of glucose and lipid) found that DM [adjusted OR 4.98 (95% CI: 1.18, 21.01), p=0.03] was independently associated with CVD.

CONCLUSIONS: Diabetics with superimposed GN were more likely to have concomitant cardiovascular risk factors and increased glucose and lipid levels after IS therapy. DM was an independent risk factor for CVD after IS therapy.