Abstract: FR-PO469
Assessment of the Relationship Between the 2010 Pathologic Classification and Renal Outcomes in Patients with Diabetic Nephropathy: A Meta-Analysis
Session Information
- Diabetic Kidney Disease: Clinical - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Feng, Qiqi, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Lou, Tan-qi, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, GUangDong, China
Background
The pathologic classification for diabetic nephropathy (DN) established by the Renal Pathology Society in 2010 has received extensive attention. However, its relationship with renal prognosis requires further study.
Methods
Original cohort studies were identified by searching PubMed, Embase, the Cochrane Library, CNKI and other resource. Hazard ratios (HRs) were pooled using the RevMan 5.3 software.
Results
Of the 1549 relevant articles, six retrospective or prospective cohort studies with a total of 803 participants were finally included in the meta-analysis. The pooled HRs revealed that the risks for renal end-points of Class I and IIa were obviously lower than those of Class IIb, III and IV, and in turn, the risks of Class IIb and III were lower than that of Class IV. But there were no significant differences between Class I and IIa, and between Class IIb and III. The pooled HRs for tubular, interstitial and vascular changes showed that interstitial fibrosis and tubular atrophy (IFTA) and interstitial inflammation were significantly correlated to renal outcomes while arteriolar hyalinosis and arteriosclerosis were not (Table 1). Subgroup analyses and sensitivity analyses indicated that different types of diabetes generated heterogeneity.
Conclusion
The present meta-analysis revealed that 1) the glomerular classes were not completely associated with renal prognosis in that the renal outcomes were benign in Class I and IIa, moderate but similar in Class IIb and III and severe in Class IV; 2) the tubular and interstitial lesions were independent variables associated with renal outcomes while vascular changes were not.
Table 1 Results of statistical pooling
| N | HR (95%CI) | P-value | Heterogeneity | ||
| P-value | I2 (%) | ||||
| Glomerular classes | |||||
| I vs IIa | 206 | 0.39 (0.08, 1.87) | 0.24 | 0.99 | 0 |
| IIb vs IIa | 266 | 2.64 (1.53, 4.54) | 0.0005** | 0.88 | 0 |
| III vs IIa | 422 | 3.06 (1.92, 4.89) | ＜0.00001** | 0.23 | 30 |
| IV vs IIa | 272 | 7.54 (4.22, 13.45) | ＜0.00001** | 0.68 | 0 |
| III vs IIb | 425 | 1.01 (0.53, 1.92) | 0.98 | 0.05 | 59 |
| IV vs IIb | 256 | 2.98 (1.88, 4.71) | ＜0.00001** | 0.67 | 0 |
| IV vs III | 417 | 2.11 (1.67, 2.68) | ＜0.00001** | 0.63 | 0 |
| Intersitial and vascular scorings | |||||
| IFTA | 519 | 1.74 (1.37, 2.20) | ＜0.00001** | 0.30 | 18 |
| Interstitial inflammation | 474 | 1.62 (1.09, 2.40) | 0.02* | 0.10 | 64 |
| Arteriolar hyalinosis | 519 | 0.81 (0.49, 1.35) | 0.43 | 0.84 | 0 |
| Arteriosclerosis | 519 | 1.04 (0.61, 1.77) | 0.88 | 0.63 | 0 |
Note: interstitial fibrosis and tubular atrophy, IFTA; *P<0.05, **P<0.01.