Observational Study
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World J Diabetes. Mar 15, 2025; 16(3): 100059
Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.100059
Prevalence and clinical characteristics of chronic kidney disease among patients with newly diagnosed ketosis-onset diabetes
Meng-Han Li, Man-Rong Xu, Yu-Jie Wang, Li Shen, Ming-Yun Chen, Lian-Xi Li
Meng-Han Li, Man-Rong Xu, Yu-Jie Wang, Lian-Xi Li, Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
Li Shen, Clinical Research Center, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
Ming-Yun Chen, Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Co-corresponding authors: Ming-Yun Chen and Lian-Xi Li.
Author contributions: Li LX and Chen MY designed the study, reviewed, and edited the manuscript, they contributed equally to this article and are the co-corresponding authors; Li MH, Xu MR, and Wang YJ collected the samples and clinical data; Li MH performed the statistical analysis and wrote the manuscript; Shen L guided the statistical analysis; All authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81770813 and No. 82070866; and Joint Funds for the Innovation of Science and Technology, Fujian Province, No. 2020Y9106.
Institutional review board statement: This study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Shanghai, China), Approval No. 2018-KY-018(K).
Informed consent statement: The study was conducted in accordance with the policies of the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and all the subjects signed an informed consent form.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at lilx@sjtu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lian-Xi Li, MD, PhD, Professor, Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, No. 600 Yishan Road, Shanghai 200233, China. lilx@sjtu.edu.cn
Received: August 6, 2024
Revised: October 28, 2024
Accepted: December 10, 2024
Published online: March 15, 2025
Processing time: 167 Days and 20.5 Hours
Abstract
BACKGROUND

The prevalence and clinical characteristics of chronic kidney disease (CKD) among patients with ketosis-onset diabetes (also known as ketosis-prone diabetes) remain unclear. Furthermore, the classification of ketosis-onset diabetes remains controversial and requires further investigation.

AIM

To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.

METHODS

This real-world study included 217 patients with type 1 diabetes mellitus (T1DM), 698 with ketosis-onset diabetes, and 993 with non-ketotic T2DM. The prevalence and clinical characteristics of CKD were compared among the three groups. Risk factors associated with CKD were evaluated using binary logistic regression for each group.

RESULTS

After adjusting for age and sex, the prevalence of CKD among patients with ketosis-onset diabetes (17.8%) was significantly higher than that in those with T1DM (8.3%, P = 0.007), but was not statistically different compared to those with non-ketotic T2DM (21.7%, P = 0.214). Furthermore, some risk factors for CKD, including age, and serum uric acid and C-reactive protein levels, in patients with ketosis-onset diabetes were similar to those with T2DM, but significantly different from those with T1DM.

CONCLUSION

The prevalence, clinical characteristics, and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM. These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.

Keywords: Ketosis-onset diabetes; Ketosis-prone diabetes; Type 1 diabetes mellitus; Type 2 diabetes mellitus; Chronic kidney disease; Diabetic nephropathy

Core Tip: The classification of ketosis-onset diabetes remains controversial, and the prevalence and clinical features of chronic kidney disease (CKD) among those with diabetes remain unclear. Results of the present study demonstrated that the prevalence, clinical characteristics, and risk factors for CKD in patients with ketosis-onset diabetes were similar to those with non-ketotic type 2 diabetes mellitus (T2DM) but distinct from those with T1DM. Therefore, from the perspective of CKD, ketosis-onset diabetes may be more appropriately classified as a subtype of T2DM than of T1DM.