Synergism Between Circulating Tumor Necrosis Factor Receptor 2 and HbA1c in Determining Renal Decline During 5–18 Years of Follow-up in Patients With Type 1 Diabetes and Proteinuria
| العنوان: | Synergism Between Circulating Tumor Necrosis Factor Receptor 2 and HbA1c in Determining Renal Decline During 5–18 Years of Follow-up in Patients With Type 1 Diabetes and Proteinuria |
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| المؤلفون: | Maciej T. Malecki, Josyf C. Mychaleckyj, Andrzej T. Galecki, Andrzej S. Krolewski, Tomohito Gohda, James H. Warram, Monika A. Niewczas, Jan Skupien |
| المصدر: | Diabetes Care |
| بيانات النشر: | American Diabetes Association, 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Time Factors, Endocrinology, Diabetes and Metabolism, Urology, Renal function, urologic and male genital diseases, Kidney Function Tests, chemistry.chemical_compound, Internal medicine, Diabetes mellitus, Internal Medicine, Humans, Receptors, Tumor Necrosis Factor, Type II, Medicine, Longitudinal Studies, Pathophysiology/Complications, Glycated Hemoglobin, Advanced and Specialized Nursing, Creatinine, Type 1 diabetes, Proteinuria, business.industry, Drug Synergism, Prognosis, medicine.disease, 3. Good health, Diabetes Mellitus, Type 1, Endocrinology, chemistry, Kidney Failure, Chronic, Female, Glycated hemoglobin, Tumor necrosis factor receptor 2, medicine.symptom, business, Biomarkers, Follow-Up Studies, Glomerular Filtration Rate, Kidney disease |
| الوصف: | OBJECTIVE We studied the serum concentration of tumor necrosis factor receptor 2 (TNFR2) and the rate of renal decline, a measure of the intensity of the disease process leading to end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS A cohort of 349 type 1 diabetic patients with proteinuria was followed for 5–18 years. Serum TNFR2, glycated hemoglobin A1c (HbA1c), and other characteristics were measured at enrollment. We used a novel analytic approach, a joint longitudinal-survival model, fitted to serial estimates of glomerular filtration rate (eGFR) based on serum creatinine (median seven per patient) and time to onset of ESRD (112 patients) to estimate the rate of renal decline (eGFR loss). RESULTS At enrollment, all patients had chronic kidney disease stage 1–3. The mean (±SD) rate of eGFR loss during 5–18 years of follow-up was −5.2 (±4.9) mL/min/1.73 m2/year. Serum TNFR2 was the strongest determinant of renal decline and ESRD risk (C-index 0.79). The rate of eGFR loss became steeper with rising concentration of TNFR2, and elevated HbA1c augmented the strength of this association (P = 0.030 for interaction). In patients with HbA1c ≥10.1% (87 mmol/mol), the difference in the rate of eGFR loss between the first and fourth quartiles of TNFR2 was 5.4 mL/min/1.73 m2/year, whereas it was only 1.9 in those with HbA1c CONCLUSIONS Circulating TNFR2 is a major determinant of renal decline in patients with type 1 diabetes and proteinuria. Elevated HbA1c magnifies its effect. Although the mechanisms of this synergism are unknown, our findings allow us to stratify patients according to risk of ESRD. |
| تدمد: | 1935-5548 0149-5992 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::da1780fc9b125d9a65d701081e222ab4Test https://doi.org/10.2337/dc13-1983Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....da1780fc9b125d9a65d701081e222ab4 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19355548 01495992 |
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