Usefulness of urinary tubule injury markers for predicting progression of renal dysfunction in patients with type 2 diabetes and albuminuria: The Fukuoka Diabetes Registry
Usefulness of urinary tubule injury markers for predicting progression of renal dysfunction in patients with type 2 diabetes and albuminuria: The Fukuoka Diabetes Registry
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DOI：
10.1016/j.diabres.2022.109840
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发表时间：
2022-03-23
影响因子：
5.1
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Ide, Hitoshi;Iwase, Masanori;Kitazono, Takanari
目的：我们前瞻性研究了日本2型糖尿病患者肾小管损伤标志物与估计肾小球滤过率（eGFR）下降的相关性。检测2例患者的尿肾损伤分子1（KIM-1）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肝型脂肪酸结合蛋白（L-FABP）和尿白蛋白/肌酐比值（UACR），685例2型糖尿病患者。肾功能的结果是eGFR从基线下降>= 30%，5年内eGFR每年下降>= 30%。结果：在正常白蛋白尿的参与者中，没有肾小管标志物与eGFR下降>= 30%或eGFR每年变化相关。在UACR >= 30 mg/gCr的患者中，eGFR下降>= 30%的风险比为1.37尿KIM-1（95%置信区间（CI）1.07-1.75）（>1.5微克/克铬），1.46尿NGAL（95% CI 1.13-1.66）（>16.4 μ g/gCr）和1.26 μ g/gCr尿L-FABP（95% CI 0.94-1.66）（>12.5微克/克铬），2.61（95%CI 1.64-4.17），在多变量调整后，包括UACR和eGFR，高于临界值的3个肾小管标志物的组合。目前的研究表明，肾小管损伤标志物及其组合是2型糖尿病和白蛋白尿患者未来eGFR下降的重要预测因子，独立于UACR和eGFR。肾小管标志物可能有助于识别蛋白尿高危患者。
Aims: We prospectively investigated the association of urinary tubule injury markers with estimated glomerular filtration rate (eGFR) decline in Japanese patients with type 2 diabetes.Methods: Urinary kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty-acid-binding protein (L-FABP), and urinary albumin-to creatinine ratio (UACR) were measured in 2,685 participants with type 2 diabetes. Renal outcomes were >= 30% decline in eGFR from the baseline and annual eGFR decline for 5 years.Results: In normoalbuminuric participants, no tubular markers were associated with >= 30% decline in eGFR or annual eGFR changes. In those with UACR >= 30 mg/gCr, hazard ratios for >= 30% eGFR decline were 1.37 (95% confident interval (CI) 1.07-1.75) for urinary KIM-1 (>1.5 mu g/gCr), 1.46 (95% CI 1.13-1.66) for urinary NGAL (>16.4 mu g/gCr), and 1.26 (95% CI 0.94-1.66) for urinary L-FABP (>12.5 mu g/gCr), 2.61 (95% CI 1.64-4.17) for the combination of 3 tubular markers above the cutoff after multivariable adjustments including UACR and eGFR.Conclusions: The current study demonstrated that urinary tubule injury markers and their combination were significant predictors for the future eGFR decline in those with type 2 diabetes and albuminuria independently of UACR and eGFR. Urinary tubular markers may be useful to identify high-risk patients with albuminuria.