Filtration Markers as Predictors of ESRD and Mortality in Southwestern American Indians With Type 2 Diabetes

Autor: Meredith C. Foster, Chi-yuan Hsu, Peter H. Bennett, Ramachandran S. Vasan, Paul L. Kimmel, John H. Eckfeldt, Andrew S. Levey, Josef Coresh, Lesley A. Inker, Robert G. Nelson, Bryan D. Myers, Meda E. Pavkov
Rok vydání: 2015
Předmět:
Male
Kidney Glomerulus
Comorbidity
Kaplan-Meier Estimate
Type 2 diabetes
chemistry.chemical_compound
Risk Factors
Interquartile range
Ethnicity
Medicine
Diabetic Nephropathies
Prospective Studies
Prospective cohort study
education.field_of_study
biology
Arizona
Middle Aged
Lipocalins
Intramolecular Oxidoreductases
Nephrology
Hypertension
Disease Progression
Female
Disease Susceptibility
Glomerular Filtration Rate
Adult
medicine.medical_specialty
Population
Renal function
Hyperlipidemias
Article
Predictive Value of Tests
Internal medicine
Humans
education
Creatinine
business.industry
Proportional hazards model
medicine.disease
Endocrinology
Diabetes Mellitus
Type 2
chemistry
Cystatin C
Indians
North American
biology.protein
Kidney Failure
Chronic
beta 2-Microglobulin
business
Biomarkers
Follow-Up Studies
Zdroj: American Journal of Kidney Diseases. 66:75-83
ISSN: 0272-6386
DOI: 10.1053/j.ajkd.2015.01.013
Popis: Background A growing number of serum filtration markers are associated with mortality and end-stage renal disease (ESRD) in adults. Whether β-trace protein (BTP) and β 2 -microglobulin (B2M) are associated with these outcomes in adults with type 2 diabetes is not known. Study Design Longitudinal cohort study. Setting & Participants 250 Pima Indians with type 2 diabetes (69% women; mean age, 42 years; mean diabetes duration, 11 years). Predictors Serum BTP, B2M, and glomerular filtration rate measured by iothalamate clearance (mGFR) or estimated using creatinine (eGFR cr ) or cystatin C level (eGFR cys ). Outcomes & Measurements Incident ESRD and all-cause mortality through December 2013. HRs were reported per interquartile range decrease of the inverse of BTP and B2M (1/BTP and 1/B2M) using Cox regression. Improvement in risk prediction with the addition of BTP or B2M level to established markers (eGFR cys with mGFR or eGFR cr ) was evaluated using C statistics, continuous net reclassification improvement, and relative integrated discrimination improvement (RIDI). Results During a median follow-up of 14 years, 69 participants developed ESRD and 95 died. Both novel markers were associated with ESRD in multivariable models. BTP level remained statistically significant after further adjustment for mGFR (1/BTP, 1.53 [95% CI, 1.01-2.30]; 1/B2M, 1.54 [95% CI, 0.98-2.42]). B2M level was associated with mortality in multivariable models and after further adjustment for mGFR (HR, 2.12; 95% CI, 1.38-3.26). The addition of B2M level to established markers increased the C statistic for mortality but only weakly when assessed by either continuous net reclassification improvement or RIDI; none was improved for ESRD by the addition of these markers. Limitations Small sample size, single measurements of markers. Conclusions In Pima Indians with type 2 diabetes, BTP and, to a lesser extent, B2M levels were associated with ESRD. B2M level was associated with mortality after adjustment for traditional risk factors and established filtration markers. Further studies are warranted to confirm whether inclusion of B2M level in a multimarker approach leads to improved risk prediction for mortality in this population.
Databáze: OpenAIRE
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