Kidney Week

Abstract: TH-PO228

Multiparametric Magnetic Resonance Imaging Allows the Prediction of Diabetic Kidney Disease Progression

Session Information

• Diabetic Kidney Disease: Clinical - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Makvandi, Kianoush, Sahlgrenska universitetssjukhuset, Goteborg, Sweden

Kianoush Makvandi,

• Hockings, Paul, Antaros Medical, Gotenburg, Sweden

Paul Hockings,

• Jensen, Gert, Sahlgrenska universitetssjukhuset, Goteborg, Sweden

Gert Jensen,

• Hulthe, Johannes, Antaros Medical, Gotenburg, Västra Götaland, Sweden

Johannes Hulthe,

• Haraldsson, Henrik, Antaros Medical, Gotenburg, Västra Götaland, Sweden

Henrik Haraldsson,

• Baid-Agrawal, Seema, Sahlgrenska universitetssjukhuset, Goteborg, Sweden

Seema Baid-Agrawal,

Background

We recently showed that a comprehensive non-contrast multiparametric Magnetic Resonance Imaging (mpMRI) allowed functional and structural assessment of diabetic kidney disease (DKD). We further investigated whether the MRI biomarkers could predict disease progression.

Methods

In this prospective study, 38 DKD subjects aged 18–79 years and 20 age- and gender-matched healthy volunteers (HV) were included at baseline. 31 DKD subjects (2 stage 2, 13 stage 3, 14 stage 4, and 2 stage 5) and 17 HV were reexamined at 2 years ± 6 months. Clinical examination, iohexol clearance for measured glomerular filtration rate (mGFR), urine albumin:creatinine ratio and mpMRI were done at both visits. A wide range of MRI biomarkers associated with kidney hemodynamics, oxygenation and macro/microstructure were evaluated. Disease progression was defined by at least one of the following at 2 years: a) decrease in mGFR slope of >5 mL/year/1.73m², b) worsening UACR category or c) any major adverse kidney event defined as sustained decrease in eGFR of >40%/doubling of serum creatinine from baseline, development of kidney failure with mGFR <15 ml/min/1.73m² or death from renal cause. Univariable logistic regression analyses were performed to discriminate between progressors and non-progressors using each imaging endpoint as a predictor variable.

Results

Mean 2-year mGFR decline (ml/min/1.73m²) in DKD patients was -2.7± 5.37 and in HV -1.9 ± 10.71. R1 cortex (measure of longitudinal nuclear MR relaxation rate for molecular environment) showed an area under ROC curve of 0.88 (p=0.0074) in DKD subjects (Figure 1) and 0.69 (p=0.032) in the whole population.

Conclusion

The imaging biomarker R1 cortex, which reflects molecular environment- viscosity, fibrosis and inflammation (interstitial oedema, cellular swelling) showed significant predictive property for progression of DKD. A confirmatory study with R1 cortex as a pre-specified endpoint is required to confirm these results.

Figure 1. ROC-curve of R1 cortex for predicting progression in DKD patients who have progressed according to at least one of criteria defined in a, b or c

Funding

• Commercial Support – Antaros Medical AB, AstraZeneca