1. Intraglomerular Dysfunction Predicts Kidney Failure in Type 2 Diabetes.
- Author
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Saulnier PJ, Looker HC, Mauer M, Najafian B, Gand E, Ragot S, Nelson RG, and Bjornstad P
- Subjects
- Adult, Arizona epidemiology, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 physiopathology, Diabetic Nephropathies epidemiology, Diabetic Nephropathies pathology, Diabetic Nephropathies physiopathology, Disease Progression, Female, Follow-Up Studies, Glomerular Filtration Rate, Hemodynamics physiology, Humans, Incidence, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic physiopathology, Kidney Glomerulus pathology, Kidney Glomerulus physiopathology, Male, Middle Aged, Prognosis, Renal Insufficiency epidemiology, Renal Insufficiency pathology, Renal Insufficiency physiopathology, American Indian or Alaska Native statistics & numerical data, Diabetes Mellitus, Type 2 diagnosis, Diabetic Nephropathies diagnosis, Renal Insufficiency diagnosis
- Abstract
No longitudinal data link intraglomerular hemodynamic dysfunction with end-stage kidney disease (ESKD) in people with type 2 diabetes (T2D). Afferent (R
A ) and efferent (RE ) arteriolar resistance and intraglomerular pressure (PGLO ) are not directly measurable in humans but are estimable from glomerular filtration rate (GFR), renal plasma flow (RPF), blood pressure, hematocrit, and plasma oncotic pressure. We examined the association of the RA -to-RE ratio and PGLO with ESKD incidence in 237 Pima Indian individuals with T2D who underwent serial measures of GFR (iothalamate) and RPF ( p -aminohippurate). Their association with kidney structural lesions was also examined in a subset of 111 participants. Of the 237 participants (mean age 42 years, diabetes duration 11 years, and GFR 153 mL/min and median urine albumin-to-creatinine ratio 36 mg/g), 69 progressed to ESKD during a median follow-up of 17.5 years. In latent class analysis, distinct trajectories characterized by increasing RA -to-RE ratio (HR 4.60, 95% CI 2.55-8.31) or elevated PGLO followed by a rapid decline (HR 2.96, 95% CI 1.45-6.02) strongly predicted incident ESKD. PGLO ( R2 = 21%, P < 0.0001) and RA -to-RE ratio ( R2 = 15%, P < 0.0001) also correlated with mesangial fractional volume, a structural predictor of DKD progression. In conclusion, intraglomerular hemodynamic parameters associated strongly with incident ESKD and correlated with structural lesions of DKD., (© 2021 by the American Diabetes Association.)- Published
- 2021
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