{"title":"活检证实的 2 型糖尿病肾病患者的肾脏病变与心血管事件风险。","authors":"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","doi":"10.1007/s10157-024-02576-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study assessed the association of pathological kidney lesions with cardiovascular events in biopsy-proven diabetic kidney disease (DKD) with type 2 diabetes.</p><p><strong>Methods: </strong>This multicenter, retrospective study involved 244 patients with no previous cardiovascular events before biopsy, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m<sup>2</sup> 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>In DKD with type 2 diabetes, advanced glomerulosclerosis, interstitial inflammation, and arteriolar hyalinosis were associated with cardiovascular events, adding predictive value to clinical features.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Kidney lesions and risk of cardiovascular events in biopsy-proven diabetic kidney disease with type 2 diabetes.\",\"authors\":\"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\",\"doi\":\"10.1007/s10157-024-02576-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study assessed the association of pathological kidney lesions with cardiovascular events in biopsy-proven diabetic kidney disease (DKD) with type 2 diabetes.</p><p><strong>Methods: </strong>This multicenter, retrospective study involved 244 patients with no previous cardiovascular events before biopsy, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m<sup>2</sup> 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>In DKD with type 2 diabetes, advanced glomerulosclerosis, interstitial inflammation, and arteriolar hyalinosis were associated with cardiovascular events, adding predictive value to clinical features.</p>\",\"PeriodicalId\":10349,\"journal\":{\"name\":\"Clinical and Experimental Nephrology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-10-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10157-024-02576-6\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10157-024-02576-6","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景本研究评估了活检证实的糖尿病肾病（DKD）与2型糖尿病患者病理肾脏病变与心血管事件的关联：这项多中心回顾性研究涉及244名患者，他们在活检前未发生过心血管事件，活检时估计肾小球滤过率（eGFR）≥30 mL/min/1.73 m2（基线），活检后观察时间≥1年。结果为首次发生的心血管事件（心血管死亡、非致死性心肌梗死、冠状动脉介入治疗或非致死性卒中），心血管事件之前的非心血管死亡被视为竞争事件。研究还调查了每种病变的严重程度与心血管事件之间的关联：随访期间（中位数：6.4年），43名患者发生了心血管事件。不同心血管事件的基线临床特征并无差异。系膜溶解、全肾小球硬化≥50%、中度/重度间质炎症和中度/重度动脉透明变性患者的心血管事件累积发生率高于各病变程度较轻的患者。精细格雷回归模型显示，肾小球硬化≥50%（亚分布危险比 [SHR]：3.85；95%置信区间 [SHR]：3.85；95%置信区间 [SHR]：3.85）：3.85；95% 置信区间 [95% CI] 1.28-11.52）、中度/重度间质性炎症（SHR：2.49；95% CI 1.18-5.29）和中度/重度动脉透明变性（SHR：3.51；95% CI 1.15-10.69）与心血管事件风险的增加有关，此前已对包括基线使用 RAAS 抑制剂在内的临床变量进行了调整。将这些病变的严重程度添加到临床变量中可提高心血管事件的预测价值：结论：在患有2型糖尿病的DKD患者中，晚期肾小球硬化、间质炎症和动脉透明变性与心血管事件相关，增加了临床特征的预测价值。
Kidney lesions and risk of cardiovascular events in biopsy-proven diabetic kidney disease with type 2 diabetes.
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.
期刊介绍：
Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.
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