NEPHROLOGY - ORIGINAL PAPER Factors related to nephrotic-range proteinuria in late-stage chronic kidney disease patients with diabetes mellitus Yit-Sheung Yap • Hung-Yi Chuang • Wen-Che Chi • Cheng-Hao Lin • Yi-Wen Wu • Pai-Chun Chang • Yi-Chun Liu Received: 28 June 2012 / Accepted: 3 January 2013 Ó Springer Science+Business Media Dordrecht 2013 Abstract Purpose Diabetic nephropathy and proteinuria are important risk factors for both end-stage renal disease and cardiovascular events. The present study aimed to identify the factors associated with nephrotic- range proteinuria in patients with advanced diabetic nephropathy. Methods This cross-sectional study enrolled 386 diabetic patients with chronic kidney disease (CKD) stages 3–5, from our outpatient Department of Nephrology. Urinary protein-to-creatinine ratio was recorded. Additionally, other laboratory parameters, body mass index, blood pressure, comorbidities, and medications were also reviewed. Results The mean age of the patients was 65.1 ± 11.6 years. Among patients with CKD stage 3 and 4, the odds ratio (OR) for nephrotic-range proteinuria in relation with systolic blood pressure significantly increased starting from 121 mmHg (OR 7.04 and 11.79 for systolic blood pressure of 121–140 and C141 mmHg, respectively, in comparison with systolic blood pressure below 121 mmHg). In addition, serum phosphorus C4.7 mg/dl was associated with significantly higher risk (OR 15.45) for severe proteinuria, compared with a phosphorus level B2.6 mg/dl. Finally, hypertriglyceri- demia C241 mg/dl was also associated with higher OR for severe proteinuria, compared with a triglyceride level B200 mg/dl. Similar associations were found in patients with CKD stage 5. Conclusions Higher systolic blood pressure, serum phosphorus, and triglyceride levels are associated with nephrotic-range proteinuria in patients with diabetic nephropathy and CKD stage 3–5. Further studies should clarify whether a reduction in serum phosphorus would lead to a decrease in proteinuria in these patients. Keywords Diabetic nephropathy Á Nephrotic-range proteinuria Á Serum phosphorus Á Blood pressure Á Chronic kidney disease Introduction The development of microalbuminuria is the first clinical sign of a classic course of diabetic Y.-S. Yap Á W.-C. Chi Á C.-H. Lin Á Y.-C. Liu (&) Division of Nephrology, Department of Internal Medicine, Yuan’s General Hospital, No. 162, Chenggong 1st Rd., LingYa District, Kaohsiung 802, Taiwan, ROC e-mail: lidenyy@yahoo.com.tw H.-Y. Chuang Department of Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC H.-Y. Chuang Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC Y.-W. Wu Á P.-C. Chang Division of Nephrology, Chronic Kidney Disease Education Center, Yuan’s General Hospital, Kaohsiung, Taiwan, ROC 123 Int Urol Nephrol DOI 10.1007/s11255-013-0378-2