Longitudinal Estimated GFR Trajectories in Patients With and Without Type 2 Diabetes and Nephropathy

Weldegiorgis, Misghina; Zeeuw, Dick de; Li, Liang; Parving, Hans Henrik; Hou, Fan Fan; Remuzzi, Giuseppe; Greene, Tom; Heerspink, Hiddo J L

doi:10.1053/j.ajkd.2017.08.010

Cited by 61 publications

(72 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 Nonlinear statistical methods, such as piecewiselinear mixed effects model, 16 are able to better characterize the different profiles of renal function progression, as well as to investigate specific risk factors associated with each profile. 15,17 Therefore, our study provides a new avenue for this difficult task, at least in HIV patients with normal renal function. Future external validation with prospective international cohort like D:A:D Study would benefit a lot to characterize the real trajectories of eGFR progression, as well as the potential time window to salvage renal function and to investigate the underlying mechanisms of TDF related nephrotoxicity.…”

Section: Discussionmentioning

confidence: 92%

“…5 Regrettably, the authors used also the conventional linear analysis to address this issue, thereby the nonlinear trajectories of eGFR progression, if exist, remain unknown. As suggested by studies from CKD cohorts, linear regression methods do not exactly estimate kidney function trajectories, 17 considering the big heterogeneity with respect to kidney function, dropout and number of kidney function estimates. 34 Nonlinear statistical methods, such as piecewiselinear mixed effects model, 16 are able to better characterize the different profiles of renal function progression, as well as to investigate specific risk factors associated with each profile.…”

Section: Discussionmentioning

confidence: 99%

“…In chronic kidney disease (CKD) population, several groups have reported nonlinear trajectories of eGFR in the past few years, its implications on risk estimation have gained interest and encouraged researchers to identify time-dependent factors associated with this phenomenon in CKD with different origins. [15][16][17] However, no studies from HIV-1-infected patients have yet rigorously assessed the nonlinear changes of eGFR over time, especially in patients with normal eGFR on initiation of TDF-based antiviral therapy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Liu

Zhao

et al. 2020

TCRM

View full text Add to dashboard Cite

Purpose: Estimated glomerular filtration rate (eGFR) decline in HIV-1-infected patients exposure to tenofovir disoproxil fumarate (TDF) has been widely assessed using linear models, but nonlinear assumption is not well validated. We constructed a retrospective cohort study to assess whether eGFR decline follows nonlinearity during antiviral therapy. Patients and Methods: We examined 823 (299 of TDF users and 524 of non-TDF users) treatment-naïve HIV-1-infected participants (age ≥ 17 years, initial eGFR ≥ 90 mL/min/1.73m 2). Estimated GFR trajectories were compared by one-linear and piecewise-linear mixed effects models, before and after propensity score matching, respectively. Whether the incidence of renal dysfunction (reduced renal function [RRF], eGFR < 90 mL/min/1.73 m 2 and rapid kidney function decline [RKFD], eGFR > −3 mL/min/1.73 m 2 /year) follows nonlinearity was assessed by logistic regression. Results: The median follow-up time of this study was 10 (interquartile range, 2-20) months, during which 178 (21.6%) experienced RRF, and 451 (54.8%) experienced RKFD. The slopes (mL/min/1.73 m 2 /year) of eGFR were −5.31 (95% CI: −6.57, −4.06) before 1.40 years, 4.83 (95% CI: 1.38, 8.28) from years 1.40 to 2.30 and −3.71 (95% CI: −5.97, −1.45) after 2.30 years among TDF users. Within years 1.40-2.30, each year of TDF exposure was associated with a 78% decreased risk of RKFD (95% CI: −91%, −49%). In comparison, eGFR increased slightly at the initiation of antiviral therapy, declined after 2.15 years (−4.96; 95% CI: −5.76, −4.17) among non-TDF users. Such a progression nonlinear trajectory was missed on the assumption of one-linearity, whether in TDF or non-TDF users. Conclusion: Over the piecewise mixed-effects analyses with the advantage of revealing the true nature of the exposure outcome relationships, an interesting reverse S-shaped relationship was observed. A routine screen based on nonlinearity could be more helpful for patient management.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Liu

Zhao

et al. 2020

TCRM

View full text Add to dashboard Cite

show abstract

“…However, DKD remains the leading cause of end-stage kidney disease (ESKD) worldwide (1)(2)(3). A decline in the glomerular filtration rate (GFR) and albuminuria are the predominant clinical features of DKD (4,5). However, with extensive use of RAAS inhibitors, determining the decline in the estimated GFR (eGFR) appears to be a more robust method of predicting kidney dysfunction than albuminuria measurement.…”

Section: Introductionmentioning

confidence: 99%

“…The goal of protecting kidney function in the early stage of DKD has motivated a search for risk factors affecting its susceptibility, initiation, and progression. The genetic and ethnic background, duration of diabetes, glycemia and blood pressure control, and albuminuria are associated with a decline in eGFR in patients with DKD (5,(8)(9)(10)(11). However, most participants in previous studies had diabetes and kidney diseases, and inclusion of patients with non-diabetic kidney diseases may have confounded the findings.…”

Section: Introductionmentioning

confidence: 99%

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

et al. 2019

View full text Add to dashboard Cite

Objective: This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). Method:This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our hospital were collected. Patients were allocated to two groups of rapid decliners and slow decliners according to the median eGFR slope. The associations between potential risk factors and rapid eGFR decline were analyzed using logistic regression.Results: A total of 128 eligible patients were enrolled and they had a mean age of 51.5 ± 10.7 years. During a median follow-up of 2 years, the median eGFR slope was −8.1 ± 14.4 mL/min/1.73 m 2 /year. The eGFR decline was significantly faster in patients with a family history of diabetes in first-degree relatives, nephrotic-range proteinuria, higher grades of glomerular pathology, and interstitial inflammation. No differences in the rate of the eGFR decline were observed in subgroups created according to sex, age, hypertension, glycosylated hemoglobin, diabetic retinopathy, interstitial fibrosis, and tubular atrophy. Logistic regression indicated that a family history of diabetes was independently associated with a rapid decline in eGFR, even after adjustment for factors including baseline eGFR and proteinuria. Conclusion:A family history of diabetes in first-degree relatives is independently associated with a rapid decline in eGFR in the current relatively young studied patients. Our findings suggested that early diagnosis and treatment is important for these patients.

show abstract

Review of potential biomarkers of inflammation and kidney injury in diabetic kidney disease

Khanijou

Zafari

Coughlan

et al. 2022

Diabetes Metabolism Res

View full text Add to dashboard Cite

Diabetic kidney disease is expected to increase rapidly over the coming decades with rising prevalence of diabetes worldwide. Current measures of kidney function based on albuminuria and estimated glomerular filtration rate do not accurately stratify and predict individuals at risk of declining kidney function in diabetes. As a result, recent attention has turned towards identifying and assessing the utility of biomarkers in diabetic kidney disease. This review explores the current literature on biomarkers of inflammation and kidney injury focussing on studies of single or multiple biomarkers between January 2014 and February 2020. Multiple serum and urine biomarkers of inflammation and kidney injury have demonstrated significant association with the development and progression of diabetic kidney disease. Of the inflammatory biomarkers, tumour necrosis factor receptor-1 and -2 were frequently studied and appear to hold most promise as markers of diabetic kidney disease.With regards to kidney injury biomarkers, studies have largely targeted markers of tubular injury of which kidney injury molecule-1, beta-2-microglobulin and neutrophil gelatinase-associated lipocalin emerged as potential candidates. Finally, the use of a small panel of selective biomarkers appears to perform just as well as a panel of multiple biomarkers for predicting kidney function decline.

show abstract

Longitudinal Estimated GFR Trajectories in Patients With and Without Type 2 Diabetes and Nephropathy

Cited by 61 publications

References 29 publications

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

<p>Longitudinal Progression of Estimated GFR in HIV-1-Infected Patients with Normal Renal Function on Tenofovir-Based Therapy in China</p>

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

Review of potential biomarkers of inflammation and kidney injury in diabetic kidney disease

Contact Info

Product

Resources

About