Kidney lesions and risk of cardiovascular events in biopsy-proven diabetic kidney disease with type 2 diabetes

期刊论文
发表日期：

2024年10月28日

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Miho Shimizu,
Kengo Furuichi,
Tadashi Toyama,
Masayuki Yamanouchi,
Daiki Hayashi,
Akihiko Koshino,
Keisuke Sako,
Keisuke Horikoshi,
Takahiro Yuasa,
Akira Tamai,
Taichiro Minami,
Megumi Oshima,
Shiori Nakagawa,
Shinji Kitajima,
Ichiro Mizushima,
Akinori Hara,
Norihiko Sakai,
Kiyoki Kitagawa,
Mitsuhiro Yoshimura,
Junichi Hoshino,
Yoshifumi Ubara,
Yasunori Iwata,
Takashi Wada

摘要

Background

This study assessed the association of pathological kidney lesions with cardiovascular events in biopsy-proven diabetic kidney disease (DKD) with type 2 diabetes.

Methods

This multicenter, retrospective study involved 244 patients with no previous cardiovascular events before biopsy, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m² at biopsy (baseline), and ≥ 1 year of observation after biopsy. The outcomes were the first occurrence of cardiovascular events (cardiovascular death, non-fatal myocardial infarction, coronary intervention, or non-fatal stroke), and non-cardiovascular deaths before cardiovascular events were considered competing events. The association between the severity of each pathological lesion and cardiovascular events was investigated.

Results

During follow-up (median: 6.4 years), 43 patients experienced cardiovascular events. The baseline clinical characteristics did not differ according to cardiovascular events. The cumulative incidence of cardiovascular events was higher in patients with mesangiolysis, global glomerulosclerosis ≥ 50%, moderate/severe interstitial inflammation, and moderate/severe arteriolar hyalinosis than in those having less advanced each lesion. Fine–Gray regression models revealed that global glomerulosclerosis ≥ 50% (subdistribution hazard ratio [SHR]: 3.85; 95% confidence interval [95% CI] 1.28–11.52), moderate/severe interstitial inflammation (SHR: 2.49; 95% CI 1.18–5.29), and moderate/severe arteriolar hyalinosis (SHR: 3.51; 95% CI 1.15–10.69) were linked to increased risk of cardiovascular events, after adjusting for clinical variables including RAAS inhibitors use at baseline. Adding the severity of these lesions to clinical variables improved the predictive value for cardiovascular events.

Conclusions

In DKD with type 2 diabetes, advanced glomerulosclerosis, interstitial inflammation, and arteriolar hyalinosis were associated with cardiovascular events, adding predictive value to clinical features.