Sex differences in risk factors for end-stage kidney disease and death in type 2 diabetes: A retrospective cohort study

BACKGROUND

This study investigated the sex differences in the risk of end-stage kidney disease (ESKD) and mortality, as well as the effect modification of sex on associated factors in patients with type 2 diabetes.

METHODS

This multicenter observational cohort study included 4328 patients with type 2 diabetes. Hazard ratios (HRs) with 95% confidence intervals (CIs) of sex for ESKD and death were estimated using Cox proportional regression with adjustment for baseline covariates. For assessing risk modification, HRs and incidence rates for ESKD and death were compared between sexes across patient characteristics using Cox proportional and Poisson regression models.

RESULTS

During a median follow-up of 7 years, 276 patients (70% men) developed ESKD, and 241 patients (68% men) died. Men had higher risks of ESKD (HR 1.34; 95% CI 1.02-1.75; p = .034) and death (HR 1.64; 95% CI 1.24-2.16; p = .001) versus women after adjusting for multiple covariates. Among patients with microalbuminuria, men had a substantially higher risk of ESKD versus women, compared to those with normo- and macroalbuminuria (p for interaction .04). Incidence rates were also increased in men versus women with albuminuria of around 300 mg/g. No differences were detected in the association of sex and death across baseline patient subgroups.

CONCLUSIONS

In type 2 diabetes, men had an increased risk of ESKD and death versus women. Moderately increased albuminuria was strongly associated with sex difference in developing ESKD.

Association between Hypokalemia and Albuminuria in a Japanese General Population

INTRODUCTION

Hypokalemia is associated with an increased risk of chronic kidney disease (CKD) and is a risk factor for mortality. Albuminuria is an early manifestation of CKD. We investigated the association between hypokalemia and the prevalence of albuminuria in a Japanese general population.

METHODS

We analyzed the data of 18,289 subjects who underwent annual health checkups in 2018. We categorized them into four groups according to their concentration of serum potassium (sK) and performed a multivariate logistic regression analysis to determine the association between hypokalemia and the prevalence of albuminuria in this population. Hypokalemia was defined as having an sK = 3.1-3.5 mEq/L. After dividing the subjects into those with/without renal dysfunction, those with/without hypertension, and those with/without hyperglycemia, we examined the association between hypokalemia and albuminuria in each group.

RESULTS

Compared to the subjects with sK = 4.1-4.5 mEq/L, the subjects with hypokalemia had a significantly high prevalence of albuminuria: multivariable-adjusted odds ratio (OR) = 2.70 (95% confidence interval [CI] 1.84-3.96). The subgroup analyses showed the following multivariable-adjusted ORs (95% CIs) of the subjects: without renal dysfunction, 3.08 (2.00-4.73); with renal dysfunction, 2.05 (0.89-4.69); without hypertension, 2.89 (1.36-6.16); with hypertension, 2.60 (1.67-4.04); without hyperglycemia, 2.49 (1.62-3.84); and with hyperglycemia, 3.55 (1.43-8.79).

CONCLUSIONS

Hypokalemia was significantly associated with the high prevalence of albuminuria in general population. Regardless of the presence/absence of renal dysfunction, hypertension, or hyperglycemia, hypokalemia was positively associated with the prevalence of albuminuria, and the associations were significant except for the subjects with renal dysfunction.

Synergistic deterioration of prognosis associated with decreased grip strength and hyporesponse to erythropoiesis-stimulating agents in patients undergoing hemodialysis

Introduction

We examined the combined effect of erythropoietin (EPO) hyporesponsiveness and low handgrip strength (HGS) on the prognosis of patients undergoing hemodialysis (HD).

Methods

We recruited patients with chronic kidney disease (CKD) Stage 5, who were undergoing HD at our dialysis clinic between January 2015 and March 2015 (n = 182). Patients of ≥20 years of age and who had been undergoing HD for ≧3 months at enrollment were eligible for inclusion. Seven patients treated with epoetin-β pegol were excluded. First, the erythropoietin resistance index (ERI) and HGS were measured. The patients were stratified by the ERI of 9.44 (U/kg/week/g/dL), and by the HGS of 28 kg for men and 18 kg for women. We then observed death and cardiovascular disease (CVD), composite endpoint (deaths or CVD) for a median of 2 years.

Results

A total of 175 patients (male, n = 122; female, n = 53; age, 34–92 years) were included in the analysis. During the observation period of 24 months, 57 events (14 deaths and 43 CVD) were observed. High ERI and low HGS were associated with a high incidence of endpoints compared to low ERI and high HGS. Among the four groups classified by ERI and HGS values, the highest risk group was the high ERI/low HGS group (HR: 4.20 95% CI 2.12–8.33).

Conclusions

EPO hyporesponsiveness combined with low HGS were found to be significant predictors of a poor outcome, and the synergistic effects of the two factors had stronger predictive ability than either single factor.

POS1339 FACTORS RELATED TO SERUM IgG4 ELEVATION AND DEVELOPMENT OF IgG4-RELATED DISEASE: DATA FROM RESIDENT EXAMINATION

Background

Elevated serum IgG4 levels are one of the characteristic findings in immunoglobulin G4 (IgG4)-related disease (IgG4-RD). Serum IgG4 levels have an impact to a certain extent on the diagnosis of IgG4-RD although there are some issues in their sensitivity and specificity. In the reports from Japan, China, USA, and Europe, elevated serum IgG4 levels were reported to be observed in 83-97% of patients with IgG4-RD [1-5]. In the past investigations of hospital patients, some studies reported that 10-15% of hospital patients with elevated serum IgG4 levels had IgG4-RD [6,7]. However, in general adults with no symptom, investigations of prevalence of elevated serum IgG4 levels and/or IgG4-RD have rarely been conducted.

Objectives

This study aimed to investigate the frequency of serum IgG4 elevation in the general Japanese population and its associated factors using data from resident examinations.

Methods

We measured the serum IgG4 levels in 1,204 residents who underwent a general medical examination in Ishikawa prefecture, Japan. Logistic regression analysis was used to search for factors related to elevated serum IgG4 levels. Secondary examinations were conducted for participants in whom elevation was identified.

Results

The mean serum IgG4 level was 44 mg/dL, and elevated serum IgG4 levels were observed in 42 patients (3.5%). Univariate logistic regression analyses showed that male sex, older age, lower estimated glomerular filtration rates based on cystatin C (eGFR-CysC), serum high-density lipoprotein cholesterol levels, and higher hemoglobin A1c (HbA1c) levels were associated with elevated serum IgG4 levels. Subgroup analyses in men showed that older age, lower eGFR-CysC levels, and higher serum HbA1c levels were associated with elevated serum IgG4 levels. In contrast, the analyses in women found no significant factors. One of the 10 residents who underwent secondary examinations was diagnosed with possible IgG4-related retroperitoneal fibrosis.

Conclusion

In the general population, elevated serum IgG4 levels are more common in elderly men, which is similar to the epidemiological features of IgG4-RD.

References

[1]Inoue D, et al. IgG4-related disease: dataset of 235 consecutive patients. Medicine (Baltimore). 2015;94(15):e680.

[2]Yamada K, et al. New clues to the nature of immunoglobulin G4-related disease: a retrospective Japanese multicenter study of baseline clinical features of 334 cases. Arthritis Res Ther. 2017;19(1):262

[3]Culver EL, et al. Elevated serum IgG4 levels in diagnosis, treatment response, organ involvement, and relapse in a prospective IgG4-related disease UK cohort. Am J Gastroenterol 2016;111:733–43.

[4]Lin W, et al. Clinical characteristics of immunoglobulin G4-related disease: a prospective study of 118 Chinese patients. Rheumatology (Oxford). 2015;54(11):1982–90.

[5]Carruthers MN, et al. The diagnostic utility of serum IgG4 concentrations in IgG4-related disease. Ann Rheum Dis 2015;74:14-18.

[6]James Yun, et al. Poor positive predictive value of serum immunoglobulin G4 concentrations in the diagnosis of immunoglobulin G4-related sclerosing disease. Asia Pac Allergy. 2014 Jul;4(3):172-176.

[7]Taiwo N Ngwa, et al. Sreum immunoglobulin G4 ｌevel is a poor predictor of immunoglobulin G4–related disease. Pancreas. 2014 Jul;43(5):704-7.

Disclosure of Interests

None declared

Effects of Body Weight Change on Development of Chronic Kidney Disease in Obese Metabolic Phenotypes

Introduction

Obesity is a risk factor for chronic kidney disease (CKD), but whether the reduction of body mass index (BMI) helps prevent CKD is controversial. Recently, obese metabolic phenotypes have raised considerable interest. We thus investigated the effect of BMI change on CKD development.

Methods

We analyzed the data of 6,959 subjects who underwent annual health checkups in both 2013 and 2018. The subjects were categorized into five groups according to their BMI percentage change (ΔBMI) and classified into four obese metabolic phenotypes. By a multivariate logistic regression analysis, we investigated the association between BMI change and CKD development within the 5 years.

Results

In total subjects, compared with the maintained BMI group (ΔBMI ≥0% but <2.5%), the odd ratios (ORs) and 95% confidence intervals (CIs) of CKD development were 0.70 (95% CI 0.54–0.91) for the severe BMI decrease group (ΔBMI <−2.5%), and 1.40 (95% CI 1.08–1.81) for the severe BMI increase group (ΔBMI ≥5%). In the metabolically healthy obese (MHO) phenotype, the risks of CKD development were significantly higher in the moderate BMI increase group (ΔBMI ≥2.5% but <5%) (OR 3.04, 95% CI 1.19–7.78) and a severe BMI increase group (OR 2.88, 95% CI 1.13–7.35). Regarding the metabolically unhealthy nonobese (MUNO) phenotype, the risks of CKD development were significantly lower in the severe BMI decrease group (OR 0.43, 95% CI 0.25–0.74) and the moderate BMI decrease group (ΔBMI ≥−2.5% but <0%) (OR 0.58, 95% CI 0.35–0.98).

Conclusions

In the MHO phenotype, an increased BMI deteriorated CKD development, and a decreased BMI ameliorated CKD development in the MUNO phenotype.

AB0760 HIGH SERUM IGA LEVELS HAVE LIMITED CLINICAL SIGNIFICANCE IN PATIENTS WITH IGG4-RELATED DISEASE DIAGNOSED BY EXPERTS

Background:

While the diagnostic and classification criteria for IgG4-related disease (IgG4-RD) have been recently developed [1-3], it is known that, without appropriate exclusions, some non-IgG4-RDs may meet these criteria. In particular, hyper IL-6 syndromes, including Castleman disease, can be misdiagnosed as IgG4-RD. Some clinical findings, including elevated serum levels of C-reactive protein (CRP) or IgA, have been suggested to be useful for differentiating hyper IL-6 syndromes from IgG4-RD [4]. However, since few clinical studies have focused on IgG4-RD with high serum IgA levels, its clinical significance has not been well known.

Objectives:

This study aimed to clarify the clinical significance of high serum IgA levels in patients with IgG4-RD.

Methods:

We retrospectively investigated the clinical features of 170 patients with IgG4-RD on the basis of the presence or absence of elevated serum IgA levels (>410 mg/dL) at the time of diagnosis. The diagnosis of IgG4-RD was made by experts on the basis of the fulfillment of the comprehensive diagnostic criteria and/or each organ-specific diagnostic criteria.

Results:

Elevated serum IgA levels were observed in 18 patients (10.6%). In the patients with elevated serum IgA levels, serum CRP levels were higher (1.14 ± 1.18 vs. 0.31 ± 0.63 mg/dL, p=0.003) and the prevalence of relapse during the clinical course was lower (5.6% vs. 27.6%, p=0.046) than in those without elevated serum IgA levels. However, there were no significant differences in the other clinical features including the number of involved organs (2.4 ± 1.3 vs. 2.8 ± 1.6, p=0.443) and inclusion scores of the ACR/EULAR classification criteria (32 ± 14 vs. 36 ± 17, p=0.374). To evaluate the influence of serum IgA elevation on relapse, we performed Cox regression analysis, which showed that the elevated serum IgA levels had no significant association with lower incidence of relapse but a tendency of it (hazard ratio 0.997, 95% confidence interval 0.994-1.000, p=0.055) during the clinical course. In addition, a prompt improvement in the IgG4-RD responder index [5] during the clinical course was seen in the patients with serum IgA elevation, suggesting a similar good response to glucocorticoids as in those without it.

Conclusion:

The findings of the present study suggest that IgG4-RD patients with high serum IgA levels can be diagnosed and treated in the same way as those without it, although they may be characterized by mild serum CRP elevation.

References:

[1]Wallace ZS et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis. 2020;79:77-87.

[2]Umehara H et al. The 2020 Revised Comprehensive Diagnostic (RCD) Criteria for IgG4-RD. Mod Rheumatol. 2020 Dec 4:1-14. doi: 10.1080/14397595.2020.1859710. Online ahead of print.

[3]Umehara H et al. Current approach to the diagnosis of IgG4-related disease - Combination of comprehensive diagnostic and organ - specific criteria. Mod Rheumatol. 2017;27:381-91.

[4]Sato Y et al. Systemic IgG4-related lymphadenopathy: A clinical and pathologic comparison to multicentric Castleman’s disease. Mod Pathol.2009;22:589-99.

[5]Carruthers MN et al. Development of an IgG4-RD Responder Index. Int J Rheumatol. 2012;2012:259408.

Disclosure of Interests:

None declared

Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes

INTRODUCTION

Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD.

RESEARCH DESIGN AND METHODS

Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk.

RESULTS

Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m²/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5-5 mL/min/1.73 m²/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m²/year compared with those with a minor change in UACR and eGFR.

CONCLUSIONS

Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.

POS1348 MORTALITY AND ITS RELATED FACTORS IN PATIENTS WITH IGG4-RELATED DISEASE: A JAPANESE SINGLE-CENTER STUDY

Background:

In recent years, IgG4-related disease (IgG4-RD) has become a widely recognized disorder. However, mortality and its related factors in this disease are not well known.

Objectives:

This study aimed to clarify mortality and its related factors in patients with IgG4-RD.

Methods:

We retrospectively reviewed the medical records of patients with IgG4-RD diagnosed by experts based on fulfillment of the Japanese comprehensive diagnostic criteria and/or the 2019 ACR/EULAR classification criteria for IgG4-RD at a single center in Japan. Using the collected data, we calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.

Results:

A total of 179 patients with IgG4-RD were included: 124 were male (69.3%); the median age was 68 years (interquartile range [IQR] 60-75 years); and the median follow-up from diagnosis was 47 months (IQR 17-84). Ten patients (5.6%) in our cohort died during the follow-up period. Five died of malignancy, one of respiratory failure, two of infectious pneumonia, one of sudden cardiac event, and one of suspected aortic aneurysmal rupture. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths were expected to occur within the follow-up period, resulting in a SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), serum creatinine levels at diagnosis (HR 1.82, 95% CI 1.06-3.12), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death, whereas the other factors including age at diagnosis and serum C-reactive protein and IgG4 levels at diagnosis did not.

Conclusion:

Our findings suggest that the mortality rate of patients with IgG4-RD does not significantly differ from that of the Japanese general population. Multi-organ involvement and renal dysfunction at diagnosis as well as malignancy during the clinical course may be associated with higher mortality. An appropriate clinical evaluation for the early detection of these risk factors is required at first diagnosis and during long-term follow-up.

Disclosure of Interests:

None declared

Quantitative sonographic assessment of quadriceps muscle thickness for fall injury prediction in patients undergoing maintenance hemodialysis: an observational cohort study

Background

Accidental fall risk is high in patients undergoing maintenance hemodialysis. Falls are associated with fatal injury, comorbidities, and mortality. Risk assessment should be a primary component of fall prevention. This study investigated whether quadriceps muscle thickness measured using ultrasonography can predict fall injury among dialysis patients.

Methods

Using an observational cohort study design, 180 ambulatory hemodialysis patients were recruited from 2015 to 2016 from four dialysis clinics. The sum of the maximum quadriceps muscle thickness on both sides and the average of the maximum thigh circumference and handgrip strength after hemodialysis were calculated. Patients were stratified according to tertiles of quadriceps muscle thickness. Fall injury was surveyed according to the patient’s self-report during the one-year period.

Results

Among the 180 hemodialysis patients, 44 (24.4%) had fall injuries during the 12-month follow-up period. When the quadriceps muscle thickness levels were stratified into sex-specific tertiles, patients in the lowest tertile were more likely to have a higher incidence of fall injury than those in the higher two tertiles (0.52 vs. 0.19 and 0.17 fall injuries/person-year). After adjusting for covariates, lower quadriceps muscle thickness was found to be an independent predictor of fall injury (hazard ratio [95% confidence interval], 2.33 [1.22–4.52], P < 0.05). Receiver operating characteristic curves were constructed to determine the optimal cutoffs of quadriceps muscle thickness, thigh circumference, and handgrip strength that best predicted fall injury (quadriceps muscle thickness, 3.37 cm and 3.54 cm in men and women; thigh circumference, 44.6 cm and 37.2 cm in men and women; and handgrip strength, 23.3 kg and 16.5 kg in men and women). Using these cutoff values, the areas under the curve were 0.662 (95% CI, 0.576–0.738), 0.625 (95% CI, 0.545–0.699), and 0.701 (95% CI, 0.617–0.774), for quadriceps muscle thickness, thigh circumference, and handgrip strength, respectively. Quadriceps muscle thickness was a more precise predictor of fall injury than thigh circumference and had similar diagnostic performance as handgrip strength tests in dialysis patients.

Conclusions

Quadriceps muscle thickness can be measured easily at the bedside using ultrasonography and is a precise predictor of fall injury in patients undergoing maintenance hemodialysis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02347-5.

The utility of patent ductus arteriosus closure with hemostatic clip in dogs

This study investigated the utility of patent ductus arteriosus (PDA) closure with hemostatic clip by comparing with traditional PDA closure. Medical records of 51 dogs with surgical closure of PDA were reviewed and retrospective study was conducted. 29 dogs were treated by procedure with hemostatic clip (Group HC), and 22 dogs were treated by surgical ligation (Group SL). Data pertaining to breed, sex, age and body weight at the time of surgery, echocardiographic minimal ductal diameter, duration of surgery, hemostatic clip size, echocardiographic findings, hemor-rhage, residual ductal flow and recanalization were collected from records. The results showed that procedure with hemostatic clip had been selected in lighter dogs than traditional PDA closure. Duration of surgery performed only hemostatic clip technique was significantly shorter than that in group SL. Preoperative LVIDd, E-wave and FS were significantly lower than postoperative ones. As regard all parameters, the differences between pre- and postoperative periods were not significantly different between group HC and group SL. Hemorrhage, residual ductal flow, and recanalization were not significantly different in both groups. The present study showed that procedure with hemostatic clip is beneficial in that it is available in smaller dogs and can make shorter operation duration than traditional PDA closure. Moreover, the procedure is effective for the resolution of volume overload of the left atrium and ventricle in short-term outcome. Complications including hemorrhage, residual ductal flow and recanaliza-tion were not significantly different with both techniques.

Myelin and Axonal Damage in Normal-Appearing White Matter in Patients with Moyamoya Disease

BACKGROUND AND PURPOSE

Although chronic ischemia is known to induce myelin and axonal damage in animal models, knowledge regarding patients with Moyamoya disease is limited. We aimed to investigate the presence of myelin and axonal damage in Moyamoya disease and their relationship with cognitive performance.

MATERIALS AND METHODS

Eighteen patients with Moyamoya disease (16-55 years of age) and 18 age- and sex-matched healthy controls were evaluated with myelin-sensitive MR imaging based on magnetization transfer saturation imaging and 2-shell diffusion MR imaging. The myelin volume fraction, which reflects the amount of myelin sheath; the g-ratio, which represents the ratio of the inner (axon) to the outer (axon plus myelin) diameter of the fiber; and the axon volume fraction, which reflects axonal components, were calculated and compared between the patients and controls. In the patients with Moyamoya disease, the relationship between these parameters and cognitive task-measuring performance speed was also evaluated.

RESULTS

Compared with the healthy controls, the patients with Moyamoya disease showed a significant decrease in the myelin and axon volume fractions (P < .05) in many WM regions, while the increases in the g-ratio values were not statistically significant. Correlations with cognitive performance were most frequently observed with the axon volume fraction (r = 0.52-0.54; P < .03 in the right middle and posterior cerebral artery areas) and were the strongest with the g-ratio values in the right posterior cerebral artery region (r = 0.64; P = .004).

CONCLUSIONS

Myelin-sensitive MR imaging and diffusion MR imaging revealed that myelin and axonal damage exist in patients with Moyamoya disease. The relationship with cognitive performance might be stronger with axonal damage than with myelin damage.

FRI0188 THE CLINICOPATHOLOGICAL SIGNIFICANCE OF MODIFIED NATIONAL INSTITUTES OF HEALTH ACTIVITY AND CHRONICITY SCORING SYSTEM IN LUPUS NEPHRITIS; A MULTICENTER RETROSPECTIVE STUDY

Background:

The revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) Classification of lupus nephritis (LN) 2018 defined a modified National Institutes of Health activity and chronicity scoring system for all LN classes [1]. As this was not arrived at by an evidence-based approach, its clinicopathological significance including prognostic value should be validated [1]. Furthermore, though the activity index included wire-loop lesion and hyaline deposits (WL), we previously demonstrated that WL was associated with serological immune abnormality, but not renal prognosis [2].

Objectives:

We conducted this study to clarify the relationships of modified activity score (AS) and chronicity score (CS) to clinical parameters at the time of renal biopsy and renal and life prognoses, and also to investigate the impact of AS without WL.

Methods:

We enrolled 138 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2019. We measured clinical findings at the time of renal biopsy, and determined the presence of comorbidities. We also measured serum creatinine and estimated glomerular filtration rate (eGFR) at the last patient visit, and recorded medications prescribed for LN. Renal biopsy findings were classified by the modified ISN/RPS classification 2018 including AS and CS for all LN classes. On stepwise multivariate analysis, we applied the variables with significant differences in univariate comparisons. The primary endpoint was chronic kidney disease (CKD; eGFR <60 ml/min/1.73m2) and/or death.

Results:

Of 138 patients (116 females; median 39 years old), class I, II, III, IV, and V included 2 (1.4%), 13 (9.4%), 43 (31.2%), 69 (50.0%), and 11 (8.0%), respectively. Median AS, AS without WL (AS-WL), and CS were 4, 3, and 2, respectively. AS ≥5 group (61 patients, 44.2%) had higher proteinuria, hematuria and serum anti-ds DNA antibodies levels and lower serum total protein (TP) and C3 levels than AS <5 group. CS ≥3 group (58 patients, 42%) had higher age, proteinuria, serum C3 levels, and frequency of hypertension (HT) and lower eGFR and serum anti-ds DNA antibodies and IgG levels than CS<3 group. Multiple regression analysis revealed significant associations between AS and hematuria, TP and C3 (β=0.312, -0.281, -0.213;p<0.001, 0.001, 0.009), and between CS and age (β=0.300;p=0.010). Next, patients who achieved the primary endpoint had higher age, frequencies of HT and hyperlipidemia and lower eGFR, serum TP and IgG levels than patients who did not. Observation period (median 36 vs 47 months,p=0.696) and medications for LN did not differ between these groups. Cox regression analysis revealed significant associations of prognosis with eGFR and TP clinically (β=0.955, 3.349;p=0.025, 0.008), and with CS pathologically (β=1.231,p=0.028). Neither AS nor AS-WL was included in the prognostic factors. Kaplan-Meier method with log-rank tests showed a significant difference in cumulative rate of CKD and/or death between CS ≥3 and CS <3 groups (p=0.049).

Conclusion:

AS and CS were related to different clinical parameters at the time of renal biopsy. CS was associated with renal and life prognoses, while neither AS nor AS-WL was. These results revealed that these scores have different clinicopathological significance in LN.

References:

[1]Bajema IM, et al. Kidney Int. 2018;93:789-96.

[2]Zoshima T, et al. Lupus 2019, accepted.

Disclosure of Interests:

None declared

Subclinical hypothyroidism is associated with albuminuria in Japanese nondiabetic subjects

PURPOSE

Thyroid dysfunction is a risk factor of cardiovascular disease (CVD), and albuminuria is a predictor of CVD. For preventing the CVD, it is essential to clarify from which stage of thyroid dysfunction the risk of CVD starts developing. We thus investigated the association between subclinical thyroid dysfunction and albuminuria, focusing on a nondiabetic general population.

METHODS

We analyzed the data of 17,221 nondiabetic subjects who underwent annual health checkups by multivariate logistic regression analyses.

RESULTS

Compared with the subjects with euthyroidism, those with subclinical hypothyroidism presented a higher prevalence of albuminuria. By a multivariate logistic regression analysis, subclinical hypothyroidism showed a significant and independent association with the high prevalence of albuminuria compared with euthyroidism (OR 1.64, 95% CI 1.21-2.21, p = 0.001). In accord with this result, the analysis in which the lowest quartile of thyroid stimulating hormone (TSH) concentration (<0.96 µIU/mL) was used as a reference revealed that the highest quartile (>2.07 µIU/mL) had a significant and independent association with the prevalence of albuminuria (OR 1.23, 95% CI 1.01-1.51, p = 0.04). One microliter unit per milliliter increase of the serum concentration of TSH also had a significant and independent association with the prevalence of albuminuria (OR 1.07, 95% CI 1.02-1.12, p = 0.006). The association between subclinical hyperthyroidism and the prevalence of albuminuria was not significant.

CONCLUSION

Our data indicated that subclinical hypothyroidism was significantly and independently associated with the high prevalence of albuminuria.

P0825ASSOCIATION OF BODY MASS INDEX CHANGES WITH CHRONIC KIDNEY DISEASE IN A JAPANESE GENERAL POPULATION

Background and Aims

Obesity is a risk factor for chronic kidney disease (CKD), but the effect of reducing body mass index (BMI) on the prevention of CKD is controversial. One of reasons for this disagreement is that part of patients with a BMI decrease may have an unfavourable health status. In such cases, the BMI decrease could be a risk factor for the development of CKD. Therefore, by analysing the data of annual health check-ups, we examined an association between BMI change and CKD development to determine whether BMI reduction helps prevent CKD development.

Method

We analysed the data of 6,959 subjects who underwent annual health check-ups in both 2013 and 2018. By a multivariate logistic regression analysis, we investigated a relationship between BMI change and CKD development within the 5 years between 2013 and 2018. The percent change in the BMI (ΔBMI) was calculated using the following equation: {(BMI in 2018 − BMI in 2013)/BMI in 2013} ×100. For analyses, we classified the subjects into five groups based on their ΔBMI value: (i) severe BMI decrease (ΔBMI &lt;−2.5%); (ii) moderate BMI decrease (ΔBMI ≥−2.5% but &lt;0%); (iii) maintained BMI (ΔBMI ≥0% but &lt;2.5%); (iv) moderate BMI increase (ΔBMI ≥2.5% but &lt;5%); (v) severe BMI increase (ΔBMI ≥5%). For further analysis, we divided the subjects into non-obesity category (basal BMI &lt;25 Kg/m2) and obesity category (basal BMI ≥25 Kg/m2). Subjects with an estimated glomerular filtration rate &lt;60 mL/min./1.73 m2 were defined as having a CKD.

Results

After adjusting several covariates, compared with the maintained BMI group, the severe BMI decrease group showed a significantly low risk of CKD development (odds ratio (OR) 0.70, 95% confidence intervals (CI) 0.54-0.91, p &lt;0.01) and the severe BMI increase group had a significantly high risk (OR 1.40, CI 1.08-1.81, p = 0.01). A farther analysis revealed that the OR of CKD development for the severe BMI increase group in the obesity category was higher than that in the non-obesity category (OR 1.75 vs. 1.29).

Conclusion

In subjects who underwent annual health check-ups, BMI reduction had a significant effect on the prevention of CKD development, whereas an increase in the BMI was a risk factor for CKD development. Moreover, by severe increase in the BMI, obesity subjects showed higher risk of CKD development than non-obesity subjects.

FRI0166 HIGH FREQUENCY OF KIDNEY STONES AND/OR NEPHROCALCINOSIS IN PRIMARY SJOGREN’S SYNDROME MIGHT ACCELERATE CHRONIC RENAL DYSFUNCTION DUE TO TUBULOINTERSTITIAL DISEASE

Background:

The renal involvement of primary Sjögren’s syndrome (pSS) is characterized by distal renal tubular acidosis (RTA), tubulointerstitial nephritis (TIN), and/or glomerulonephritis [1,2]. Kidney stones and nephrocalcinosis are presumably caused by subclinical distal tubular acidosis, but its clinical significance has not been clarified.

Objectives:

This study aimed to clarify the frequency and clinical features of patients with pSS with kidney stones and/or nephrocalcinosis.

Methods:

We examined 59 patients with anti SS-A/Ro positive pSS who underwent abdominal computed tomography and/or ultrasound between 1998 and 2019 at Kanazawa University Hospital. We identified 2 groups of patients with primary Sjögren’s syndrome: 1) patients with kidney stones and/or nephrocalcinosis (group A: n=19) and 2) those without kidney stones and/or nephrocalcinosis (group B: n=40), and retrospectively analyzed their clinical features.

Results:

Kidney stones and/or nephrocalcinosis were confirmed in 19 of 59 (32%) patients with pSS. The patients comprised 4 males and 55 females with an average age of 60 years (range, 30 to 83 years) and mean observation period of 96 months (range 1 to 336 months). Estimated glomerular filtration rate (eGFR) at the time of diagnostic imaging (group A vs group B: 71.5 ml/min/1.73 m2vs 82.8 ml/min/1.73 m2; p=0.37) and eGFR at last follow up (group A vs group B: 59.3 ml/min/1.73 m2vs 74.7 ml/min/1.73 m2;p=0.03) of group A were lower than those of group B and urinary β2-microgloblin (group A vs group B: 7222 μg/mL vs 437 μg/mL; p=0.01) and urinary N-acetyl-β-D-glucosaminidase (group A vs group B: 5.8 U/L vs 3.9 U/L; p=0.22) of group A were higher than those of group B, while serum electrolytes (sodium, potassium, chloride, calcium, phosphorus), fractional excretion of calcium (group A vs group B: 1.2% vs1.5%; p=0.916), ESSDAI (group A vs group B: 7.6 vs 4.3; p=0.069), and eGFR decrease rate were not significantly different.

Conclusion:

32% patients with anti SS-A/Ro positive pSS had kidney stones and/or nephrocalcinosis in our cohort and their presence might accelerate chronic renal dysfunction due to tubulointerstitial disease (subclinical RTA or TIN).

References:

[1]Jain A et al. Renal involvement in primary Sjogren’s syndrome: a prospective cohort study. Rheumatol Int 2018; 38: 2251-62.

[2]Jasiek M et al. A multicentre study of 95 biopsy-proven cases of renal disease in primary Sjögren’s syndrome. Rheumatology 2017; 56: 362-70.

Acknowledgments:

We thank Mr. John Gelblum for critical reading of the manuscript.

Disclosure of Interests:

None declared

SAT0532 POSITIVE DISEASE-SPECIFIC AUTOANTIBODIES LOWER DIAGNOSTIC SENSITIVITY BUT HAVE LITTLE CLINICAL SIGNIFICANCE IN DIAGNOSING IgG4-RELATED DISEASE USING THE 2019 ACR/EULAR CLASSIFICATION CRITERIA IN DAILY CLINICAL PRACTICE

Background:

Recently, the 2019 ACR/EULAR classification criteria for IgG4-related disease (IgG4-RD) were published mainly to identify more homogeneous subjects for inclusion in clinical trials and observational studies [1]. However, although their high specificity is presumed to be useful to differentiate IgG4-RD from various mimickers, their value in daily clinical practice needs to be evaluated.

Objectives:

This study aimed to clarify the usefulness of the 2019 ACR/EULAR classification criteria for IgG4-RD and characteristics of false-negative patients in daily clinical practice.

Methods:

We retrospectively reviewed the medical records of 162 patients with IgG4-RD and 130 consecutive non-IgG4-RD patients (mimickers) diagnosed by experts whose serum IgG4 levels were measured at a single center in Japan. Using the collected data, we calculated sensitivity, specificity, and fulfillment rates for the entry criteria, exclusion criteria, and threshold of inclusion criteria points. In addition, to clarify the characteristics of false-negative cases in IgG4-RD, we performed an intergroup comparison of their clinical features including disease-specific autoantibodies.

Results:

Both the patients with IgG4-RD and mimickers were relatively old (66 and 65 years) with male predominance (67% and 60%). The final diagnoses of mimickers mainly consisted of cancer, lymphoma, vasculitis, sarcoidosis, multicentric Castleman’s disease, and atherosclerotic or infectious aortic aneurysm. The classification criteria had a sensitivity of 72.8% and a specificity of 100%. Of the 44 false-negative cases, one did not fulfill the entry criteria, 20 fulfilled one exclusion criterion, and 27 did not achieve sufficient inclusion criteria points. Compared with the true-positive cases, the false-negative cases had significantly fewer affected organs, lower serum IgG4 levels, higher serum CH50 levels, and lower prevalence of salivary/lacrimal gland and renal parenchymal lesions. They were also less likely to have had biopsies (61% vs 97%). Of note, positivity of disease-specific autoantibodies including SSA/Ro antibody, ANCA, ds-DNA antibody, and ACPA was the most common exclusion criterion fulfilled in 18 patients, only 2 of whom were diagnosed with a specific autoimmune disease (rheumatoid arthritis) complicated by IgG4-RD. The remaining 16 patients had no specific clinical symptoms related to such autoantibodies. In addition, compared with IgG4-RD patients without disease-specific autoantibodies, the 18 patients with them had almost equal serum IgG4 and complement levels, number of affected organs, and histopathology and immunostaining scores despite higher serum IgG and CRP levels.

Conclusion:

The present study suggests that the 2019 ACR/EULAR classification criteria for IgG4-RD has excellent diagnostic specificity and moderate sensitivity in daily clinical practice. Positive disease-specific autoantibodies alone, which lowered the sensitivity in this study, may have little clinical significance concerning the diagnosis of IgG4-RD.

References:

[1]Wallace ZS et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis. 2020 Jan;79(1):77-87.

Disclosure of Interests:

None declared

Wire-loop lesion is associated with serological immune abnormality, but not renal prognosis, in lupus nephritis

BACKGROUND

Wire-loop lesion (WL) is one of the active lesions of lupus nephritis (LN). However, few reports have focused on the clinicopathological relationships of WL to serological immune abnormality and renal prognosis.

METHODS

We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. In patients with class III or IV of the International Society of Nephrology/Renal Pathology Society classification, we retrospectively compared clinicopathological findings between those with WL (WL+ group) and without WL (WL- group) to detect factors associated with WL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m² for more than three months. We also compared these findings between those with CKD (CKD+ group) and without CKD (CKD- group) at the last visit to investigate factors associated with renal prognosis.

RESULTS

Of 126 patients, 100 (79.4%) were classified as class III or IV. WL was found in 36 (36.0%) of them. Although the renal function did not differ, the WL+ group had a higher titre of serum anti-dsDNA antibodies and lower serum complement 3 levels than the WL- group. Linear regression analysis revealed a significant association only between anti-dsDNA antibodies and WL (β = 0.27, 95% confidence interval (CI) 0.001-0.100, p = 0.01). Of these patients, 69 were tracked for 59.6 ± 55.1 months. Kaplan-Meier analysis showed no difference in renal prognosis between these groups. Next, the CKD+ group included 15 (22.1%) patients. They were older and had higher frequencies of hypertension and hyperuricaemia, serum creatinine (Cr) level, glomerulosclerosis, interstitial inflammation, interstitial fibrosis and tubular atrophy than the CKD- group at the time of renal biopsy. The frequency of WL was not significantly different. Cox regression analysis revealed significant associations of CKD with hypertension, hyperuricaemia, serum Cr level at the time of renal biopsy clinically and with tubular atrophy histologically.

CONCLUSIONS

WL was associated with serum anti-dsDNA antibodies but not with renal prognosis, suggesting that WL reflects immune abnormality but is not an independent factor predictive of renal prognosis in LN.

Bayesian Estimation of CBF Measured by DSC-MRI in Patients with Moyamoya Disease: Comparison with 15O-Gas PET and Singular Value Decomposition

BACKGROUND AND PURPOSE

CBF analysis of DSC perfusion using the singular value decomposition algorithm is not accurate in patients with Moyamoya disease. This study compared the Bayesian estimation of CBF against the criterion standard PET and singular value decomposition methods in patients with Moyamoya disease.

MATERIALS AND METHODS

Nineteen patients with Moyamoya disease (10 women; 22-52 years of age) were evaluated with both DSC and ¹⁵O-gas PET within 60 days. DSC-CBF maps were created using Bayesian analysis and 3 singular value decomposition analyses (standard singular value decomposition, a block-circulant deconvolution method with a fixed noise cutoff, and a block-circulant deconvolution method that adopts an occillating noise cutoff for each voxel according to the strength of noise). Qualitative and quantitative analyses of the Bayesian-CBF and singular value decomposition-CBF methods were performed against ¹⁵O-gas PET and compared with each other.

RESULTS

In qualitative assessments of DSC-CBF maps, Bayesian-CBF maps showed better visualization of decreased CBF on PET (sensitivity = 62.5%, specificity = 100%, positive predictive value = 100%, negative predictive value = 78.6%) than a block-circulant deconvolution method with a fixed noise cutoff and a block-circulant deconvolution method that adopts an oscillating noise cutoff for each voxel according to the strength of noise (P < .03 for all except for specificity). Quantitative analysis of CBF showed that the correlation between Bayesian-CBF and PET-CBF values (ρ = 0.46, P < .001) was similar among the 3 singular value decomposition methods, and Bayesian analysis overestimated true CBF (mean difference, 47.28 mL/min/100 g). However, the correlation between CBF values normalized to the cerebellum was better in Bayesian analysis (ρ = 0.56, P < .001) than in the 3 singular value decomposition methods (P < .02).

CONCLUSIONS

Compared with previously reported singular value decomposition algorithms, Bayesian analysis of DSC perfusion enabled better qualitative and quantitative assessments of CBF in patients with Moyamoya disease.

Experimental study of fast-neutron production and moderation for accelerator-based BNCT system

This work aims to study the fast-neutron production and moderation for the development of a compact accelerator-based multi-port Boron Neutron Capture Therapy (AB-mBNCT) system. An initial energy distribution and the efficiency of a test moderator assembly (TMA) for fast neutrons from a tungsten (W) target bombarded with a 53 MeV proton beam were measured using organic scintillators. The experimental results were reproduced with reasonable accuracy by simulations using the PHITS code. This paper will discuss about the experimental outcome and the related benchmark calculations by PHITS code.

Association of Thyrotropin Concentration with Chronic Kidney Disease in a Japanese General Population Cohort

BACKGROUND

Previous studies have indicated an association between hypothyroidism and kidney dysfunction; however, few studies have investigated whether thyroid dysfunction is a risk factor for chronic kidney disease (CKD) development. And their result is not consistent.

OBJECTIVES

We evaluated the association of thyroid dysfunction with CKD prevalence and development by a multivariate logistic regression analysis.

METHOD

In cross-sectional and longitudinal studies, 16,390 subjects and 7,609 subjects, respectively, who underwent annual health check-ups were analyzed. We categorized the subjects into the following 4 groups based on their serum thyrotropin (TSH) -concentrations: below-normal (TSH < 0.54 mU/L), lower-normal -(0.54-2.40 mU/L), higher-normal (2.41-4.26 mU/L) and above-normal (> 4.26 mU/L). Subjects with eGFR <60 mL/min/1.73 m2 were determined to have CKD.

RESULTS

The cross-sectional study revealed a positive correlation between TSH concentration and CKD -prevalence. Compared with the lower-normal TSH group, the ORs and 95% CIs of CKD prevalence were 0.61 (0.45-0.82, p = 0.001) for the below-normal group, 1.49 (1.33-1.67, p < 0.001) for the higher-normal group, and 1.90 (1.57-2.30, p < 0.001) for the above-normal group. The longitudinal study revealed that the risk of CKD development within 3 years was significantly higher in the above-normal TSH group than in the lower-normal TSH group (OR 1.58, 95% CI 1.02-2.45, p = 0.04).

CONCLUSIONS

Our data indicate that higher TSH concentrations are positively correlated with CKD prevalence and that a high TSH concentration is a risk factor for CKD development.

Microwave oscillator using piezoelectric thin-film resonator aiming for ultraminiaturization of atomic clock

We developed a microwave oscillator and a micro electromechanical systems-based rubidium cell for the miniaturization of atomic clocks. A thin-film bulk acoustic resonator (FBAR) having a resonant frequency of the fundamental mode in the 3.5 GHz band was employed instead of a crystal resonator. It delivers a clock transition frequency of Rb atoms of 3.417 GHz without the need for a complicated frequency multiplication using a phase-locked loop. This topology considerably reduces the system scale and power consumption. For downsizing the atomic clock system toward the chip level as well as mass production, a microfabricated gas cell containing Rb and N₂ gases was also developed. These microcomponents were incorporated into an atomic clock test bench, resulting in a clock operation with a short-term frequency instability of 2.1 × 10^-11 at 1 s. To the best of our knowledge, this is the first report of a coherent population trapping clock operation using an FBAR-based microwave oscillator as well as a microfabricated gas cell.

Estimated glomerular filtration rate decline and risk of end-stage renal disease in type 2 diabetes

Background

According to studies by the National Kidney Foundation and Food and Drug Administration, 30% and 40% declines in estimated glomerular filtration rate (eGFR) could be used as surrogate endpoints of end-stage renal disease (ESRD). However, the benefits of using these endpoints in diabetic patients remain unclear.

Methods

This cohort study comprised Japanese patients with type 2 diabetes; those with repeated serum creatinine measurements during a baseline period of 2 years (n = 1868) or 3 years (n = 2001) were enrolled. Subsequent risks of ESRD following eGFR declines were assessed.

Results

In the 2-year baseline analysis, the cumulative prevalence of −20%, −30%, −40%, and −53% changes in eGFR were 23.9%, 11.1%, 6.8%, and 3.7%, respectively. There were 133 cases (7.1%) of subsequent ESRD during a median follow-up period of 6.5 years. In the 3-year baseline analysis, the corresponding proportions were 28.1%, 14.0%, 7.7%, and 3.9%, respectively, with 110 participants (5.5%) reaching ESRD during a median follow-up period of 5.5 years. The adjusted hazard ratios of subsequent ESRD following −53%, −40%, −30%, and −20% changes in eGFR during the 2-year baseline period were 22.9 (11.1–47.3), 12.8 (6.9–23.7), 8.2 (4.3–15.5), and 3.9 (2.2–7.0), respectively when compared with the no changes in eGFR. In the 3-year baseline analysis, the corresponding risks were 29.7 (10.8–81.9), 18.4 (7.6–44.7), 12.8 (5.2–32.2), and 5.4 (2.3–12.8), respectively. In the subgroup analysis, similar trends were observed in patients with macroalbuminuria at baseline.

Conclusions

Declines in eGFR were strongly associated with subsequent risk of ESRD in Japanese type 2 diabetic patients. In addition to 30% and 40% declines, a 20% decline in eGFR over 2 years could be considered as a candidate surrogate endpoint of ESRD in diabetic kidney disease.

Mechanical Strength of Synthetic Casting Tape for Application to Fracture Treatment of Farm Animals

Compressive and torsional strength of cyclindrically formed synthetic casting tape for animals (Vetcast Plus™), composed of polyurethane-impregnated glass fibres, was investigated to determine its adequate application to fracture treatment of farm animals. After the completion of curing reaction, six-layered samples of the synthetic casting tape tolerated a compressive load of 6630 N (680 kgf). The sixlayered casting tape had also a torsional strength of 64 N · m. The compressive strength increased with time after the initiation of curing reaction. The time required for practical curing (achieving more than 60% of a final strength) was only 30 min, and that for complete curing 120 min. It was demonstrated that efficacious and safe fracture treatment of farm animals could be carried out using the synthetic casting tape for animals when a layer number appropriate to the total body weight of the patient animal was employed. The information obtained in this study is thought to be very useful in clinical practice.

Mechanical strength of poly-urethane-impregnated synthetic casting tape was investigated to determine its adequate application to fracture treatment of farm animals. It was demonstrated that mechanical strength of cylindrically formed samples of the casting tape depended upon the layer number, and the six-layered sample tolerated a compressive load of 6630 N and a torsional load of 64 N · m when completely cured.

Standard Protocol for Exchange of Health-checkup Data Based on SGML: The Health-checkup Data Markup Language (HDML)

Objectives: To develop a health/medical data interchange model for efficient electronic exchange of data among health-checkup facilities.

Results: A Health-checkup Data Markup Language (HDML) was developed on the basis of the Standard Generalized Markup Language (SGML), and a feasibility study carried out, involving data exchange between two health checkup facilities. The structure of HDML is described.

Results: The transfer of numerical lab data, summary findings and health status assessment was successful.

Conclusions: HDML is an improvement to laboratory data exchange. Further work has to address the exchange of qualitative and textual data.

A new pathological scoring system by the Japanese classification to predict renal outcome in diabetic nephropathy

Background and objectives

The impact of the newly proposed pathological classification by the Japan Renal Pathology Society (JRPS) on renal outcome is unclear. So we evaluated that impact and created a new pathological scoring to predict outcome using this classification.

Design, setting, participants, & measurements

A multicenter cohort of 493 biopsy-proven Japanese patients with diabetic nephropathy (DN) were analyzed. The association between each pathological factor—Tervaert’ and JRPS classifications—and renal outcome (dialysis initiation or 50% eGFR decline) was estimated by adjusted Cox regression. The overall pathological risk score (J-score) was calculated, whereupon its predictive ability for 10-year risk of renal outcome was evaluated.

Results

The J-scores of diffuse lesion classes 2 or 3, GBM doubling class 3, presence of mesangiolysis, polar vasculosis, and arteriolar hyalinosis were, respectively, 1, 2, 4, 1, and 2. The scores of IFTA classes 1, 2, and 3 were, respectively, 3, 4, and 4, and those of interstitial inflammation classes 1, 2, and 3 were 5, 5, and 4 (J-score range, 0–19). Renal survival curves, when dividing into four J-score grades (0–5, 6–10, 11–15, and 16–19), were significantly different from each other (p<0.01, log-rank test). After adjusting clinical factors, the J-score was a significant predictor of renal outcome. Ability to predict 10-year renal outcome was improved when the J-score was added to the basic model: c-statistics from 0.661 to 0.685; category-free net reclassification improvement, 0.154 (-0.040, 0.349, p = 0.12); and integrated discrimination improvement, 0.015 (0.003, 0.028, p = 0.02).

Conclusions

Mesangiolysis, polar vasculosis, and doubling of GBM—features of the JRPS system—were significantly associated with renal outcome. Prediction of DN patients’ renal outcome was better with the J-score than without it.

Uric Acid Is a Strong Risk Marker for Developing Hypertension From Prehypertension: A 5-Year Japanese Cohort Study

Prehypertension frequently progresses to hypertension, a condition associated with high morbidity and mortality from cardiovascular diseases and stroke. However, the risk factors for developing hypertension from prehypertension remain poorly understood. We conducted a retrospective cohort study using the data from 3584 prehypertensive Japanese adults (52.1±11.0 years, 2081 men) found to be prehypertensive in 2004 and reexamined in 2009. We calculated the cumulative incidences of hypertension over 5 years, examined risk factors, and calculated odds ratios (ORs) for developing hypertension after adjustments for age, sex, body mass index, smoking and drinking habits, baseline systolic and diastolic blood pressure, pulse rate, diabetes mellitus, dyslipidemia, chronic kidney disease, and serum uric acid levels. The additional analysis evaluated whether serum uric acid (hyperuricemia) constituted an independent risk factor for developing hypertension. The cumulative incidence of hypertension from prehypertension over 5 years was 25.3%. There were no significant differences between women and men (24.4% versus 26.0%; P=0.28). The cumulative incidence of hypertension in subjects with hyperuricemia (n=726) was significantly higher than those without hyperuricemia (n=2858; 30.7% versus 24.0%; P<0.001). After multivariable adjustments, the risk factors for developing hypertension from prehypertension were age (OR, 1.023; P<0.001), female sex (OR, 1.595; P<0.001), higher body mass index (OR, 1.051; P<0.001), higher baseline systolic (OR, 1.072; P<0.001) and diastolic blood pressure (OR, 1.085; P<0.001), and higher serum uric acid (OR, 1.149; P<0.001). Increased serum uric acid is a strong risk marker for developing hypertension from prehypertension. Further studies are needed to determine whether treatment of hyperuricemia in prehypertensive subjects could impede the onset of hypertension.

Abstract P146: Uric Acid is an Independent Risk Factor for Developing Hypertension From Prehypertension: A 5-year Japanese Cohort Study

Objectives: Prehypertension frequently progresses to hypertension and is associated with cardiovascular diseases, stroke, excess morbidity and mortality. However, the identical risk factors for developing hypertension from prehypertension are not clarified. This study is conducted to clarify the risks.

Methods: We conducted a retrospective 5-year cohort study using the data from 3,584 prehypertensive Japanese adults (52.1±11.0 years, 2,081 men) in 2004 and reevaluated it 5 years later. We calculated the cumulative incidences of hypertension over 5 years, then, we detected the risk factors and calculated odds ratios (ORs) for developing hypertension by crude analysis and after adjustments for age, sex, body mass index, smoking and drinking habits, baseline systolic and diastolic blood pressure, pulse rate, diabetes mellitus, dyslipidemia, chronic kidney disease, and serum uric acid. We also evaluated whether serum uric acid (hyperuricemia) provided an independent risk for developing hypertension.

Results: The cumulative incidence of hypertension from prehypertension over 5 years was 25.3%, but there were no significant differences between women and men (24.4% vs 26.0%, p=0.28). The cumulative incidence of hypertension in subjects with hyperuricemia (n=726) was significantly higher than those without hyperuricemia (n=2,858) (30.7% vs 24.0%, p<0.001). After multivariable adjustments, the risk factors for developing hypertension from prehypertension were age (OR per 1 year increased: 1.023; 95% CI, 1.015-1.032), women (OR versus men: 1.595; 95% CI, 1.269-2.005), higher body mass index (OR per 1 kg/m 2 increased: 1.051; 95% CI 1.021-1.081), higher baseline systolic blood pressure (OR per 1 mmHg increased: 1.072; 95% CI, 1.055-1.089) and diastolic blood pressure (OR per 1 mmHg increased: 1.085; 95% CI, 1.065-1.106), and higher serum uric acid (OR pre 1 mg/dL increased: 1.149; 95% CI, 1.066-1.238), but not smoking and drinking habits, diabetes mellitus, dyslipidemia, and chronic kidney diseases.

Conclusions: Increased serum uric acid is an independent risk factor for developing hypertension from prehypertension. Intervention studies are needed to clarify whether the treatments for hyperuricemia in prehypertensive subjects are useful.

Paratubular basement membrane insudative lesions predict renal prognosis in patients with type 2 diabetes and biopsy-proven diabetic nephropathy

Aims

Glomerular insudative lesions are a pathological hallmark of diabetic nephropathy (DN). However, paratubular basement membrane insudative lesions (PTBMIL) have not attracted much attention, and the association between such lesions and the renal prognosis remains unclear.

Methods

Among 142 patients with biopsy-proven DN and type 2 diabetes encountered from 1998 to 2011, 136 patients were enrolled in this study. Patients were classified into 3 groups (Group 1: mild, Group 2: moderate, Group 3: severe) according to the extent of cortical and medullary PTBMIL. The endpoint was a decline of the estimated glomerular filtration rate (eGFR) by ≥ 40% from baseline or commencement of dialysis for end-stage renal disease. The Cox proportional hazard model was employed to calculate hazard ratios (HRs) and 95% confidence interval (CIs) for the death-censored endpoint.

Results

During a median follow-up period of 1.8 years (IQR: 0.9–3.5), the endpoint occurred in 104 patients. Baseline mean eGFR was 43.9 ± 22.8 ml/min/1.73 m², and 125 patients (92%) had overt proteinuria. After adjusting for known indicators of DN progression, the HR for the endpoint was 2.32 (95% CI: 1.20–4.51) in PTBMIL Group 2 and 3.12 (1.48–6.58) in PTBMIL Group 3 versus PTBMIL Group 1. Furthermore, adding the PTBMIL Group to a multivariate model including known promoters of DN progression improved prediction of the endpoint (c-index increased by 0.02 [95% CI: 0.00–0.04]).

Conclusions

PTBMIL may be useful for predicting the renal prognosis of patients with biopsy-proven DN, but further investigation of these lesions in various stages of DN is needed.