Background: Diabetes mellitus is the most common cause of chronic kidney disease (CKD), however, the inter-relationships and pathogenetic mechanisms among risk factors are still largely unknown.Structural equation models (SEMs)was applied to test a hypothesis model of causal pathways related to CKD in patients with type 2 diabetes mellitus (T2DM).

Methods: A total of 3,395 subjects with T2DM were enrolled in this study. A hypothesized SEM was applied to assess associations between demographic data, diabetic self-management behaviors, diabetes control,life style, psycho-social, chronic inflammation factors, anthropometric, and metabolic variables simultaneously and the risk of CKD.

Results: Seven baseline factors including demographic data (-0.075), white blood cell count (0.084), high blood pressure (0.144), WHO 5 well-being index (-0.082), diabetes control (0.099), triglyceride(0.091) and uric acid (0.282) levels had direct effects on the risk of CKD. The final model could explain 26%of the variability in baseline CKD status. The pathway associated with CKD was further confirmed by SEM analysis showing that the same direct and specific indirect factors as in baseline CKD status analysis contributed to the risk of CKD at 12 months of follow-up. The final model could explain 31%of the variability in the risk of CKD at 12 months of follow-up.

Conclusions: This study is the first to investigate associations between factors obtained from real world daily practice and CKD status simultaneously, and delineate the pathway and inter-relationships of the risk factors contributing to the pathogenesis of CKD in patients with T2DM.


T. Lee: None. F. Chung: None.

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