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Abstract: TH-PO915

Magnetic Resonance Imaging Biomarkers Independently Predict GFR and Urine Albumin Creatinine Ratio

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Johansson, Lars, Antaros Medical AB, Molndal, Sweden
  • Hockings, Paul, Antaros Medical AB, Molndal, Sweden
  • Makvandi, Kianoush, Sahlgrenska University Hospital, Göteborg, Sweden
  • Jensen, Gert, Sahlgrenska University Hospital, Göteborg, Sweden
  • Unnerstall, Tim, Sahlgrenska University Hospital, Göteborg, Sweden
  • Leonhardt, Henrik, Sahlgrenska University Hospital, Göteborg, Sweden
  • Jarl, Lisa, Antaros Medical AB, Molndal, Sweden
  • Englund, Camilla, Antaros Medical AB, Molndal, Sweden
  • Erlandsson, Fredrik, AstraZeneca, Gaithersburg, Maryland, United States
  • Sundgren, Anna K., AstraZeneca, Gaithersburg, Maryland, United States
  • Hulthe, Johannes, Antaros Medical AB, Molndal, Sweden
  • Baid-Agrawal, Seema, Sahlgrenska University Hospital, Göteborg, Sweden
Background

Estimated GFR (eGFR) and urine albumin/creatinine ratio (UACR) are the standard methods for assessing glomerular damage and renal function changes in clinical practice, Within-person variations are large in people with diabetes due to the complex nature of diabetic kidney disease (DKD). New non-invasive markers are needed to increase understanding of disease pathogenesis. We recently showed that magnetic resonance imaging (MRI) markers correlated strongly to both measured GFR (mGFR) and UACR. Here we seek to determine which MRI markers are independent predictors of mGFR and UACR.

Methods


Subjects: The study included 2 CKD2, 16 CKD3, and 20 CKD4 subjects with DKD, 18-79 years old, and 20 age- and gender-matched healthy controls. GFR was measured using iohexol clearance. UACR was assessed in the first morning sample.
MRI techniques:
- Renal hemodynamics with mean arterial flow (ml/s)
- Renal microstructure, such as fibrosis and cellular infiltration, by measurement of Apparent Diffusion Coefficient (ADC) (mm2s-1 x 10-3) and R1 (s-1)
- Renal oxygenation by measurement of BOLD R2* (s-1)
- Renal macrostructure by kidney volume assessment (ml)
Statistics: We performed multiple regression analyses in the control group and the CKD group separately: 1) with UACR, mean arterial flow, R1 cortex, R2* cortex, ADC cortex, and kidney volume as independent variables, and mGFR as the dependant variable; and 2) with mGFR, mean arterial flow, R1 cortex, R2* cortex, ADC cortex, and kidney volume as independent variables, and UACR as the dependent variable.

Results

The only independent predictors of mGFR in the CKD group were mean arterial flow (p < 0.0001) and kidney volume (p = 0.03), with none in the control group. The only independent predictors of UACR were cortical R1 in the CKD group (p = 0.005) and kidney volume in the control group (p = 0.01).

Conclusion

It is well known that GFR is strongly linked to renal blood flow and therefore not surprising to see mean arterial flow emerge as an independent predictor of mGFR. The strong link between cortical R1 and UACR indicates that cortical R1, a measure of cellular infiltration in the cortex where the filtration barrier exists, may be a novel biomarker of kidney damage and warrants further investigation.

Funding

  • Commercial Support