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Kidney Week

Abstract: FR-PO663

Is Urinary KIM-1 a Predictor of EGFR Decline, Incident Cardiovascular Disease, and All Cause Mortality?

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Eickhoff, Mie K., Steno Diabetes Center, Gentofte, Denmark
  • Von Scholten, Bernt Johan, Novo Nordisk A/S, Soborg, Denmark
  • Reinhard, Henrik, Steno Diabetes Center A/S, Gentofte, Denmark
  • Hansen, Tine, Steno Diabetes Center, Gentofte, Denmark
  • Persson, Frederik, Steno Diabetes Center, Gentofte, Denmark
  • Parving, Hans-Henrik, Rigshospitalet, Copenhagen, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

Urinary levels of kidney injury molecule 1 (KIM-1) has shown to reflect tubular pathophysiology. We evaluated KIM-1 as a predictor of decline in estimated glomerular filtration rate (eGFR), incident cardiovascular disease (CVD) and all-cause mortality in patients with type 2 diabetes (T2D) and microalbuminuria without clinical coronary artery disease.

Methods

We performed a prospective study including 200 patients, all receiving multifactorial treatment. Urinary KIM-1 was measured at baseline and was available in 191 patients. Adjusted Cox models included sex, age, LDL cholesterol, smoking, HbA1c, creatinine, systolic blood pressure and urine albumin excretion rate (UAER).
A decline in eGFR of >30%, which has recently been suggested as a valid renal outcome, at any time point during follow-up was the predefined endpoint of CKD progression. Hazard ratios (HR) are provided per 1 SD increment of log-transformed values of the urinary biomarker.

Results

Patients were (± SD) 59 ± 9 years old, eGFR 91.1 ± 18.3 ml/min/1.73m2 and UAER (IQR) 103 (39–230) mg/24-h. During a median 6.1 years follow-up, there were 40 incident CVD events and 26 deaths and a total of 42 patients reached the predefined CKD progression endpoint after 4.9 years (median).
Higher urinary KIM-1 was a predictor of eGFR decline, unadjusted HR (95% CI): 1.9 (1.2-2.8); p=0.003, and in the adjusted model HR 1.7 (1.0-2.7); p=0.034. For CVD events urinary KIM-1 was a determinant in the unadjusted model (HR 1.4 (1.0-2.1); p=0.04) but not in the adjusted model (HR 1.4 (1.0-2.1); p=0.08), and of all-cause mortality in unadjusted (HR 2.0 (1.2-3.2); p=0.008) and adjusted (HR 2.3 (1.2-4.1); p=0.008) models.

Conclusion

In patients with T2D and microalbuminuria receiving multifactorial treatment, urinary KIM-1 was independently associated with deterioration in renal function and all-cause mortality.