Modified arteriosclerosis score predicts the outcomes of diabetic kidney disease

BMC Nephrology

Ruizhao Li¹  Xinling Liang¹  Sheng Li²  Xiaoyan Bai²  Chunfang Qi²  Jianteng Xie²  Qiuling Li³  Yuan Zhu⁴  Qifeng Jiang⁵  Zujiao Chen⁶  Yau Hok Him⁶  Shaogui Zhang⁶  Yanhui Wang⁷  Yifan Zhang⁸  Wenjian Wang⁹ 

[1] Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;School of Medicine, South China University of Technology, 510006, Guangzhou, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;Shantou University Medical College, 515041, Shantou, China;Division of Nephrology, Wenzhou People’s Hospital, 325000, Wenzhou, China;Division of Renal Pathology, Guangzhou KingMed Diagnostic Laboratory LTD, 510320, Guangzhou, China;The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;Division of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China;The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;Division of Nephrology, Wenzhou Central Hospital, 325000, Wenzhou, China;The Second School of Clinical Medicine, Southern Medical University, 510515, Guangzhou, China;Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Main Building, Room 1436, 510080, Guangzhou, Guangdong, China;School of Medicine, South China University of Technology, 510006, Guangzhou, China;Shantou University Medical College, 515041, Shantou, China;

关键词: Arteriosclerosis;    Diabetic kidney disease (DKD);    Nomogram;    Outcomes;    Renal pathology;   

DOI  :  10.1186/s12882-021-02492-x

来源: Springer

【 摘 要 】

BackgroundThe significance of renal arteriosclerosis in the prediction of the renal outcomes of diabetic kidney disease (DKD) remains undetermined.MethodsWe enrolled 174 patients with DKD from three centres from January 2010 to July 2017. The severity and extent of arteriosclerosis were analysed on sections based on dual immunohistochemical staining of CD31 and α-smooth muscle actin. An X-tile plot was used to determine the optimal cut-off value. The primary endpoint was renal survival (RS), defined as the duration from renal biopsy to end-stage renal disease or death.ResultsThe baseline estimated glomerular filtration rate (eGFR) of 135 qualified patients was 45 (29 ~ 70) ml/min per 1.73 m2, and the average 24-h urine protein was 4.52 (2.45 ~ 7.66) g/24 h. The number of glomeruli in the biopsy specimens was 21.07 ± 9.7. The proportion of severe arteriosclerosis in the kidney positively correlated with the Renal Pathology Society glomerular classification (r = 0.28, P < 0.012), interstitial fibrosis and tubular atrophy (IFTA) (r = 0.39, P < 0.001), urine protein (r = 0.213, P = 0.013), systolic BP (r = 0.305, P = 0.000), and age (r = 0.220, P = 0.010) and significantly negatively correlated with baseline eGFR (r = − 0.285, P = 0.001). In the multivariable model, the primary outcomes were significantly correlated with glomerular class (HR: 1.72, CI: 1.15 ~ 2.57), IFTA (HR: 1.96, CI: 1.26 ~ 3.06) and the modified arteriosclerosis score (HR: 2.21, CI: 1.18 ~ 4.13). After risk adjustment, RS was independently associated with the baseline eGFR (HR: 0.97, CI: 0.96 ~ 0.98), urine proteinuria (HR: 1.10, CI: 1.04 ~ 1.17) and the modified arteriosclerosis score (HR: 2.01, CI: 1.10 ~ 3.67), and the nomogram exhibited good calibration and acceptable discrimination (C-index = 0.82, CI: 0.75 ~ 0.87).ConclusionsThe severity and proportion of arteriosclerosis may be helpful prognostic indicators for DKD.

【 授权许可】

CC BY