Kidney Week

Abstract: FR-OR03

Defining Kidney Health Dimensions and Their Associations with Adverse Outcomes in Persons with Diabetes and CKD

Session Information

• CKD: Care Patterns and Novel Therapeutic Approaches
  October 25, 2024 | Location: Room 25, Convention Center
  Abstract Time: 04:50 PM - 05:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Peschard, Vanessa-Giselle, University of California San Francisco, San Francisco, California, United States

Vanessa-Giselle Peschard, MD, MA, MS, MSc

• Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States

Rebecca Scherzer, PhD

• Katz, Ronit, University of Washington, Seattle, Washington, United States

Ronit Katz, PhD

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak, MD, MS

• Ascher, Simon, University of California Davis, Davis, California, United States

Simon Ascher, MD, MPH

• Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States

James P. Lash, MD, FASN

• Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Sarah J. Schrauben, MD, MS

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Ilori, Titilayo O., Boston University, Boston, Massachusetts, United States

Titilayo O. Ilori, MD, MS, MSc

• Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States

Paul L. Kimmel, MD, FASN

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca, DO, MS

• Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Orlando M. Gutierrez, MD

• Ramachandran, Vasan S., The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States

Vasan S. Ramachandran

• Sondheimer, James H., Wayne State University, Detroit, Michigan, United States

James H. Sondheimer, MD, FASN

• Cheung, Katharine L., University of Vermont, Burlington, Vermont, United States

Katharine L. Cheung, MD, MS, PhD, FASN

• Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States

Joseph V. Bonventre, MD, PhD, FASN

• Levitan, Emily B., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Emily B. Levitan, PhD

• Schelling, Jeffrey R., Case Western Reserve University, Cleveland, Ohio, United States

Jeffrey R. Schelling, MD

• Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States

Jonathan J. Taliercio, DO, FASN

• Rao, Panduranga S., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Panduranga S. Rao, MD, MBBS, MS

• Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States

Jason Henry Greenberg, MD, FASN

• Chen, Jing, Tulane University, New Orleans, Louisiana, United States

Jing Chen, MD, MS, MSc

• Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States

Michelle M. Estrella, MD

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix, MD, FASN

• Shlipak, Michael, University of California San Francisco, San Francisco, California, United States

Michael Shlipak, MD, MPH

Group or Team Name

• CKD Biomarkers Consortium.

Background

Individual kidney tubule biomarkers are known to be associated with risks for CKD progression and mortality in persons with diabetes. Integrating multiple kidney biomarkers using an exploratory factor analysis could define distinct dimensions of kidney health, and their associations with adverse outcomes.

Methods

We conducted a factor analysis of 17 candidate urine and plasma biomarkers in 1,256 participants with diabetes and eGFR <60 ml/min/1.73 m² from the Chronic Renal Insufficiency Cohort (CRIC; n=701) and the Reasons for Geographic and Racial Differences in Stroke (REGARDS; n=555) studies. We used Cox proportional hazards models to evaluate the associations of identified factors with CKD progression and mortality, adjusting for baseline clinical risk factors, eGFR and albuminuria.

Results

Three factors comprising 10 biomarkers were identified: systemic inflammation and filtration (plasma TNFR-1, TNFR-2, suPAR, SDMA), tubular function (urine EGF, ADMA, SDMA), and tubular damage (urine α1m, KIM-1, MCP-1). In CRIC, lower tubular function and higher tubular damage were jointly and independently associated with CKD progression risk. Associations in REGARDS were weaker but directionally consistent for both tubular function and tubular damage. Lower tubular function and higher tubular damage were associated with higher mortality risk in CRIC, but not REGARDS. Higher systemic inflammation and filtration was associated with higher mortality risk in both cohorts.

Conclusion

Three distinct kidney health dimensions were identified, and each associated with CKD progression or mortality in persons with diabetes and CKD.

Funding

• NIDDK Support