Intraglomerular dysfunction may predict kidney failure in type 2 diabetes patients: Study
USA: Intraglomerular dysfunction can predict kidney failure in type 2 diabetes (T2D) patients, suggests a recent study in Diabetes, the journal of the American Diabetes Association.
The study found intraglomerular hemodynamic parameters to be strongly associated with incident end-stage kidney disease (ESKD) and correlated with structural lesions of diabetic kidney disease (DKD).
In people with type 2 diabetes, none of the longitudinal data has linked intraglomerular hemodynamic dysfunction with ESKD. Afferent (RA) and efferent (RE) arteriolar tone and intraglomerular pressure (PGLO) are estimated from glomerular filtration rate (GFR), renal plasma flow (RPF), blood pressure, hematocrit, and plasma oncotic pressure and are not directly measurable.
Against the above background, c, NIDDK, Phoenix, AZ USA, and colleagues aimed to examine the association of the RA/RE ratio and PGLO with ESKD incidence in 237 Pima Indian persons with T2D who underwent serial measures of GFR (iothalamate) and RPF (p-aminohippurate). The researchers also examined their association with kidney structural lesions in a subset of 111 participants.
Upon analysis, the researchers found the following:
- During a median follow-up of 17.5 years, out of 237 participants (mean age 42 years, diabetes duration 11 years, GFR 153 ml/min, median ACR 36 mg/g), 69 progressed to ESKD.
- In latent class analysis, distinct trajectories characterized by increasing RA/RE ratio (HR: 4.60) or elevated PGLO followed by a rapid decline (HR: 2.96) strongly predicted incident ESKD. PGLO (R2=21%,) and RA/RE (R2=15%,) also correlated with mesangial fractional volume, a structural predictor of DKD progression.
Our findings showed that intraglomerular hemodynamic parameters are associated strongly with incident ESKD and correlated with structural lesions of DKD, concluded the authors.
The study titled, "Intraglomerular dysfunction predicts kidney failure in type 2 diabetes," is published in the ADA journal Diabetes.