Filtration markers as predictors of ESRD and mortality in Southwestern American Indians with type 2 diabetes.
Am J Kidney Dis
; 66(1): 75-83, 2015 Jul.
Article
em En
| MEDLINE
| ID: mdl-25773485
ABSTRACT
BACKGROUND:
A growing number of serum filtration markers are associated with mortality and end-stage renal disease (ESRD) in adults. Whether ß-trace protein (BTP) and ß2-microglobulin (B2M) are associated with these outcomes in adults with type 2 diabetes is not known. STUDYDESIGN:
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 (eGFRcr) or cystatin C level (eGFRcys). 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 (eGFRcys with mGFR or eGFRcr) 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Indígenas Norte-Americanos
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Microglobulina beta-2
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Oxirredutases Intramoleculares
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Diabetes Mellitus Tipo 2
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Nefropatias Diabéticas
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Lipocalinas
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Falência Renal Crônica
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Glomérulos Renais
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Marrocos