The study is dedicated to solving a current problem of modern diabetology – improving the management algorithm of patients with chronic kidney disease and latent autoimmune diabetes in adults.
Due to a comprehensive clinical examination the features of the onset and course of chronic kidney disease in patients with latent autoimmune diabetes in adults were established depending on the phenotype, stage of chronic kidney disease, degree of albuminuria and cause of chronic kidney disease, as well as in comparison with classical types of diabetes.
The course of chronic kidney disease depends on the indicators of diabetic autoimmune disorders in adult patients with latent autoimmune diabetes. In patients with chronic kidney disease and latent autoimmune diabetes of adults islet antibodies are high, especially in LADA1 phenotype, but antibodies to glutamic acid decarboxylase are lower than in classical type 1 diabetes mellitus (p<0.001), indicating a lower degree of autoimmunity in this category of patients. The increase in the concentration of diabetic markers of autoimmunity in chronic kidney disease against the background of latent autoimmune diabetes in adults is associated with decrease in glomerular filtration rate (r= 0.327; p<0.05).
The degree of dyslipidemia in persons with latent autoimmune diabetes in adults is found to be the largest in LADA2 phenotype and the category of albuminuria A3 and occupy an intermediate position between classical types of diabetes. In this case, the growth of low-density lipoprotein cholesterol and atherogenic index is associated with decrease of the glomerular filtration rate (r=-0.428 and r= 0.324 respectively; p<0.05). On the contrary, higher levels of high-density lipoprotein cholesterol are associated with improved kidney function and a lower degree of albuminuria (r=0.403; p<0.05), especially in LADA2. In persons with chronic pyelonephritis and latent autoimmune diabetes in adults, the renal filtration is associated with increasing of the low-density lipoprotein cholesterol (GFRCKD EPI CysC (r=-0.560; p<0.05)).
For the first time the value of vitamin D deficiency in the formation of renal disorders in patients with latent autoimmune diabetes in adults was observed. Chronic kidney disease against the background of latent autoimmune diabetes in adults is accompanied by insufficient provision of vitamin D (insufficiency in 33.3%, deficiency – in 47.2% of patients) regardless of the phenotype of the disease and the stage of chronic kidney disease with the lowest level in the case of obvious proteinuria. A low content of vitamin D is associated with higher albuminuria and albumin creatinine ratio (r=-0.431 and r=-0.414, respectively; p<0.05), in LADA2 phenotype – with increasing of cystatin C level (r=-0.578; p<0.05) and decrease in the filtration function of the kidneys (GFRCKD-EPI CysC (r=0.578; p<0.05)).
The algorithm of chronic kidney disease management in patients with latent autoimmune adult diabetes is suggested, which includes assessment of risk factors, screening, diagnosis, treatment (non-drug, pathogenetic, symptomatic) and subsequent monitoring.
Thus, the study of the frequency of development, clinical-diagnostic features of chronic kidney disease against the background of LADA compared to classical types of diabetes, depending on anthropometric parameters, carbohydrate and lipid metabolism, insulin resistance, β-cellular function, autoimmune markers and vitamin D levels allowed identifying risk factors, mechanisms for development and advance of renal disorders in patients with LADA and improve the management algorithm of patients with chronic kidney disease in this type of diabetes.
