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Liu AYL, Pek S, Low S, Moh A, Ang K, Tang WE, Lim Z, Subramaniam T, Sum CF, Lim SC. Association of overhydration and serum pigment epithelium-derived factor with CKD progression in diabetic kidney disease: A prospective cohort study. Diabetes Res Clin Pract 2021; 174:108754. [PMID: 33741351 DOI: 10.1016/j.diabres.2021.108754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 12/01/2022]
Abstract
AIM Little is known about whether overhydration (OH), measured using bioimpedance assay (BIA), is associated with CKD progression in patients with type 2 diabetes mellitus (T2DM). We hypothesised that OH was a predictor, and pigment epithelium-derived factor (PEDF) was a modifiable risk factor of CKD progression. METHODS We conducted a prospective cohort study of 1,065 patients with clinically euvolemic T2DM who attended the diabetes centre in a tertiary hospital or primary care clinic. CKD progression was defined as a combination of the worsening of the KDIGO defined CKD category by eGFR and a ≥25% decline in eGFR compared to baseline. RESULTS Patients with T2DM in the highest tertile of OH and relative OH (OH/ extracellular water > 7%) were positively associated with CKD progression (hazard ratio [HR] 1.45 [95% confidence interval (CI) 1.14-1.85; p = 0.003 and HR 1.29 [95%CI 1.05-1.59; p = 0.017]). There were positive associations between PEDF and CKD progression (β = 1.10; p = 0.001) and between OH and CKD progression (β = 0.21; p = 0.036). OH remained positively associated with CKD progression mediated by PEDF. CONCLUSIONS OH is an independent risk factor for CKD progression in patients with T2DM. Our study supports the novel definition of PEDF as a positive mediator between OH and CKD progression.
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Affiliation(s)
- Allen Yan Lun Liu
- Department of General Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
| | - Sharon Pek
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Angela Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, Singapore 138543, Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, Singapore 138543, Singapore
| | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore; Diabetes Centre, Admiralty Medical Centre, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, Singapore 730676, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
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