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논문분류	춘계학술대회 초록집
제목	Clinicopathological predictors of rapid kidney function decliners with biopsy-proven diabetic kidney disease in type 2 diabetes
저자	Yiyang Zhao
출판정보	2024; 2024(1):
키워드
초록	Objectives: Kidney function rapid decliners in diabetic kidney disease (DKD) perform a high annual rate of estimated glomerular filtration rate (eGFR) decline and usually have poor prognoses. It is of interest to identify more proper clinicopathological predictors of rapid eGFR decliners in type 2 diabetes (T2D) patients since the performance of proteinuria alone as a predictor is far from perfect. Methods: The current study was longitudinal and retrospective, with 181 biopsy-proven DKD patients with T2D. Rapid eGFR decline was defined as the eGFR decline slope ≤ -5 ml/min/1.73 m2/year. Multivariate logistic analysis, propensity score method (PSM), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to determine clinicopathological predictors of rapid kidney function decline. Results: Among these 181 patients, 108 and 73 were classified as rapid and non-rapid decliners, respectively. In the multivariate logistic model, higher baseline eGFR, mesangiolysis/microaneurysm, and interstitial fibrosis and tubular atrophy (IFTA) were independent predictors of rapid eGFR decline [odds ratio (OR) and 95% confidence interval (CI): 1.40 (1.12-1.76), P = 0.004; 5.40 (2.37-12.29), P < 0.001; 2.92 (1.46-5.86), P = 0.002, respectively]. These variables significantly improved model fit and calibration (P < 0.001), discrimination [area under the curve 0.80 (0.73-0.86), P < 0.001], and reclassification [NRI and 95% CI: 0.83 (0.57-1.18); IDI and 95% CI: 19% (13.1%-24.8%)]. The multivariable linear regression analysis revealed that the correlation between eGFR decline slope and the variables including baseline eGFR, mesangiolysis/microaneurysm, and IFTA remained significant. Conclusions: Higher baseline eGFR, mesangiolysis/microaneurysm, and IFTA were independent predictors of rapid eGFR decline in DKD patients with T2D.
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