Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients.

IF 8.2 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2023-03-30 DOI:10.47102/annals-acadmedsg.2022350

Serena Low, Sharon Li Ting Pek, Angela Mei Chung Moh, Jonathon Khoo, Keven Ang, Wern Ee Tang, Ziliang Lim, Tavintharan Subramaniam, Chee Fang Sum, Su Chi Lim

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Abstract

Introduction: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is the angle of vector determined by the body's resistance and reactance. It indicates cellular integrity and hydration status. Though extracellular volume excess was associated with chronic kidney disease (CKD) progression, the association between PhA and CKD progression is unknown. Matrix metalloproteinase-2 (MMP-2) is a member of zinc-dependent endopeptidase family and promotes renal interstitial fibrosis. We investigated association between PhA and CKD progression, and whether the association was through MMP-2 in patients with type 2 diabetes mellitus (T2DM).

Method: We conducted a prospective study on 1,078 patients with T2DM (mean age 58.9±9.1 years). PhA was measured using BIA. CKD progression was defined as ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline with deterioration across eGFR categories. Multiplex immunoassay was used to quantitate MMP-2. We examined association between PhA and CKD progression using Cox proportional hazards model, adjusting for demographics, clinical parameters and medications.

Results: Over 8.6 years of follow-up, 43.7% of participants had CKD progression. Compared to tertile 3 PhA (higher level), tertiles 1 and 2 PhA were associated with higher hazards of CKD progression, with corresponding unadjusted hazard ratios (HRs) of 2.27 (95% confidence interval [CI] 1.80-2.87, P<0.001) and 1.57 (95% CI 1.24-2.01, P<0.001). The positive association between tertiles 1 and 2 PhA with CKD progression persisted in the fully adjusted model with corresponding HRs of 1.71 (95% CI 1.30-2.26, P<0.001) and 1.46 (95% CI 1.13-1.88, P=0.004). MMP-2 accounted for 14.7% of association between tertile 1 PhA and CKD progression.

Conclusion: Our findings revealed a previously unobserved association between BIA-derived lower PhA and CKD progression through MMP-2 in patients with T2DM.

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2型糖尿病患者低相位角与慢性肾病进展的关系

相位角(PhA)源于生物电阻抗分析(BIA)，是由人体的电阻和电抗所决定的矢量角度。它表明细胞的完整性和水合状态。虽然细胞外体积过量与慢性肾脏疾病(CKD)进展有关，但PhA与CKD进展之间的关系尚不清楚。基质金属蛋白酶-2 (Matrix metalloproteinase-2, MMP-2)是锌依赖性内肽酶家族的一员，可促进肾间质纤维化。我们研究了PhA与CKD进展之间的关系，以及这种关系是否通过2型糖尿病(T2DM)患者的MMP-2来实现。方法:对1078例T2DM患者(平均年龄58.9±9.1岁)进行前瞻性研究。PhA采用BIA法测定。CKD进展被定义为肾小球滤过率(eGFR)较基线下降≥25%，且各eGFR类别均有恶化。多重免疫分析法定量测定MMP-2。我们使用Cox比例风险模型，调整了人口统计学、临床参数和药物，研究了PhA和CKD进展之间的关系。结果:在8.6年的随访中，43.7%的参与者CKD进展。与第三位PhA(较高水平)相比，第三位PhA 1和2与CKD进展的高风险相关，相应的未调整风险比(hr)为2.27(95%可信区间[CI] 1.80-2.87, P<0.001)和1.57 (95% CI 1.24-2.01, P<0.001)。在完全调整模型中，三分之一和二分之一PhA与CKD进展之间的正相关持续存在，相应的hr分别为1.71 (95% CI 1.30-2.26, P<0.001)和1.46 (95% CI 1.13-1.88, P=0.004)。MMP-2在ttile - 1pha与CKD进展之间的关联中占14.7%。结论:我们的研究结果揭示了先前未被观察到的bia来源的低PhA与T2DM患者通过MMP-2的CKD进展之间的关联。关键词:生物阻抗分析，慢性肾病，糖尿病，基质金属蛋白酶，相位角

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.