Risk of Kidney Failure by Diagnosis and Histology in Diabetes

Résumé fourni par la source

Background: Risk of kidney failurewith diabetic nephropathy (DN) versus another diagnosis (non-DN) or mixed-DN (DN and non-DN) diagnosis is unknown. This study evaluated kidney biopsies from patients with diabetes for diagnosis and histology to predict kidney failure. Methods: The study included patients with diabetes who had a kidney biopsy at Providence and UCLA Health systems in 2015-2017. Pathology reports for diagnosis and histologic features, and demographic and clinical data were extracted from electronic health records. Patients were followed from biopsy through 2023 for kidney failure (estimated glomerular filtration rate-eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant) and death. Cumulative incidence (CMI) was estimated and SHapley Additive exPlanations (SHAP) analysis of random survival forests ranked predictors of kidney failure with competing risk of death. Results: The study population (N=477) was 54% male and had a mean±SD age of 60±12 years. Baseline eGFR was 38±26 mL/min/1.73 m2 and median (interquartile range) urine protein-to-creatinine ratio (UPCR) was 5 (2-9) g/g. Median follow-up was 6.4 (5.2-7.5) years. The 2-year CMI (95% confidence interval [CI]) for kidney failure was highest in the group with DN (n=192; 60% [53%-67%]), followed by mixed-DN (n=181; 53% [45%-60%]), and non-DN (n=104; 39% [29%-48%], Figure A). CMIs for death were much lower. The top 10 predictors of kidney failure (SHAP C-index 0.23) were lower eGFR, nodular sclerosis, younger age, higher social vulnerability index, higher UPCR, arteriolar hyalinosis, higher body mass index, higher HbA1c, DN diagnosis, and >50% global glomerulosclerosis (Figure B). Conclusion: Kidney failure occurred in over half of patients with DN or mixed-DN diagnoses within 2 years of biopsy. The most important predictors were specific histological features and DN along with clinical characteristics and social determinants. Funding: Commercial Support - Goldfinch BioCumulative incidence and predictors of kidney failure

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