Modified arteriosclerosis score predicts the outcomes of diabetic kidney disease

作者：Zhang, Yifan; Jiang, Qifeng; Xie, Jianteng; Qi, Chunfang; Li, Sheng; Wang, Yanhui; Him, Yau Hok; Chen, Zujiao; Zhang, Shaogui; Li, Qiuling; Zhu, Yuan; Li, Ruizhao; Liang, Xinling; Bai, Xiaoyan; Wang, Wenjian^*

来源：BMC Nephrology, 2021, 22(1): 281.

DOI：10.1186/s12882-021-02492-x

• Arteriosclerosis
• Diabetic kidney disease (DKD)
• Nomogram
• Outcomes
• Renal pathology

Background: The significance of renal arteriosclerosis in the prediction of the renal outcomes of diabetic kidney disease (DKD) remains undetermined. @@@ Methods: We 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 alpha-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. @@@ Results: The baseline estimated glomerular filtration rate (eGFR) of 135 qualified patients was 45 (29 similar to 70) ml/min per 1.73 m(2), and the average 24-h urine protein was 4.52 (2.45 similar to 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 similar to 2.57), IFTA (HR: 1.96, CI: 1.26 similar to 3.06) and the modified arteriosclerosis score (HR: 2.21, CI: 1.18 similar to 4.13). After risk adjustment, RS was independently associated with the baseline eGFR (HR: 0.97, CI: 0.96 similar to 0.98), urine proteinuria (HR: 1.10, CI: 1.04 similar to 1.17) and the modified arteriosclerosis score (HR: 2.01, CI: 1.10 similar to 3.67), and the nomogram exhibited good calibration and acceptable discrimination (C-index = 0.82, CI: 0.75 similar to 0.87). @@@ Conclusions: The severity and proportion of arteriosclerosis may be helpful prognostic indicators for DKD.

• 单位
  1; 广东省人民医院; 汕头大学; 南方医科大学