Defining Phenotypes in Diabetic Nephropathy: a novel approach using a cross-sectional analysis of a single centre cohort

Sci Rep. 2018 Jan 8;8(1):53. doi: 10.1038/s41598-017-18595-1.

Abstract

The global increase in Diabetes Mellitus (DM) has led to an increase in DM-Chronic Kidney Disease (DM-CKD). In this cross-sectional observational study we aimed to define phenotypes for patients with DM-CKD that in future may be used to individualise treatment We report 4 DM-CKD phenotypes in 220 patients recruited from Imperial College NHS Trust clinics from 2004-2012. A robust principal component analysis (PCA) was used to statistically determine clusters with phenotypically different patients. 163 patients with complete data sets were analysed: 77 with CKD and 86 with DM-CKD. Four different clusters were identified. Phenotypes 1 and 2 are entirely composed of patients with DM-CKD and phenotypes 3 and 4 are predominantly CKD (non-DM-CKD). Phenotype 1 depicts a cardiovascular phenotype; phenotype 2: microvascular complications with advanced DM-CKD; phenotype 3: advanced CKD with less anaemia, lower weight and HbA1c; phenotype 4: hypercholesteraemic, younger, less severe CKD. We are the first group to describe different phenotypes in DM-CKD using a PCA approach. Identification of phenotypic groups illustrates the differences and similarities that occur under the umbrella term of DM-CKD providing an opportunity to study phenotypes within these groups thereby facilitating development of precision/personalised targeted medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Comorbidity
  • Cross-Sectional Studies
  • Cytokines / metabolism
  • Diabetic Nephropathies / diagnosis*
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / metabolism
  • Female
  • Humans
  • Inflammation Mediators / metabolism
  • Male
  • Neovascularization, Pathologic
  • Phenotype*

Substances

  • Cytokines
  • Inflammation Mediators