COMPARATIVE ASSOCIATION OF ARTERIOLAR HYALINOSIS AND BLOOD PRESSURE ON KIDNEY FUNCTION DECLINE IN DIABETIC KIDNEY DISEASE AND NEPHROSCLEROSIS

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https://storage.unitedwebnetwork.com/files/1099/3a09eddb6408be7b15cc96af305d6fc9.pdf

Abstract Title *

COMPARATIVE ASSOCIATION OF ARTERIOLAR HYALINOSIS AND BLOOD PRESSURE ON KIDNEY FUNCTION DECLINE IN DIABETIC KIDNEY DISEASE AND NEPHROSCLEROSIS

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Co-author 1

Yusuke Yoshimura yoshimura@toranomon.gr.jp Toranomon Hospital Nephrology Center Tokyo Japan *

Co-author 2

Masayuki Yamanouchi m.yamanouchi@toranomon.gr.jp Toranomon Hospital Nephrology Center Tokyo Japan -

Co-author 3

Kei Kono k.kono0317@gmail.com Toranomon Hospital Department of Pathology Tokyo Japan -

Co-author 4

Kenichi Ohashi kohashi.pth1@tmd.ac.jp Toranomon Hospital Department of Pathology Tokyo Japan -

Co-author 5

Yutaka Takazawa yutakazawa@toranomon.gr.jp Toranomon Hospital Department of Pathology Tokyo Japan -

Co-author 6

Yoshifumi Ubara yoshifumitora_0418@yahoo.co.jp Toranomon Hospital Nephrology Center Tokyo Japan -

Co-author 7

Takehiko Wada twada-tky@umin.ac.jp Toranomon Hospital Nephrology Center Tokyo Japan -

Co-author 8

Naoki Sawa naokis@toranomon.gr.jp Toranomon Hospital Nephrology Center Tokyo Japan -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Despite improvements in blood pressure (BP) control, substantial residual risk of kidney outcomes persists in diabetes. Arteriolar hyalinosis, a hallmark of intrarenal vascular injury, is common in both diabetic kidney disease (DKD) and nephrosclerosis (NS). However, it remains unclear whether its associations with kidney outcomes are similar in DKD and NS and to what extent BP modifies these associations.

Methods

Retrospective biopsy-based cohort from two centers (n=367; 279 DKD, 88 NS). Arteriolar hyalinosis was graded by the proportion of arteriolar circumference affected (<10%, 10-25%, 25-50%, >50%). Outcomes were the annual eGFR decline, modeled with linear mixed-effects models, and the urinary albumin-to-creatinine ratio (UACR). Prespecified effect modification by systolic BP strata (<120, 120-140, >140 mmHg) was assessed for both outcomes.

Results

In DKD, increasing hyalinosis severity was associated with faster annual eGFR decline (p for trend <0.01) and higher UACR, and both gradients were steeper at higher BP. In NS, no significant trend in annual eGFR decline was observed (p=0.70). Even within the lowest at BP stratum, DKD patients with comparable hyalinosis showed faster decline than NS.

Conclusion

Arteriolar hyalinosis is a BP-dependent risk marker in DKD but not in NS, supporting consideration of tighter BP targets in DKD with hyalinosis.

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