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Kidney Week

Abstract: TH-PO180

The Influence of Bone on Kidney Disease Progression in Persons with Type 1 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Hauge, Sabina Chaudhary, Department of Nephrology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
  • Hjortkjær, Henrik Øder, Steno Diabetes Center Copenhagen, Herlev, Denmark
  • Persson, Frederik, Steno Diabetes Center Copenhagen, Herlev, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Denmark
  • Hansen, Ditte, Department of Nephrology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
Background

The number of patients with chronic kidney disease (CKD) and diabetes is expected to increase. Identification of mechanisms influencing the progression of CKD is of great importance. In CKD, a bone-vascular cross-talk has been described, but if bone influences on kidney function has been sparsely investigated. The aim of this study was to explore the influence of bone-derived factors (sclerostin, Dickkopf-1 (DKK1), and osteoprotegerin (OPG)) on the progression of kidney disease in persons with type 1 diabetes (T1D).

Methods

This was a prospective cohort study. Blood samples from persons with T1D were collected between 2009-2011. Outcomes were: 1) End-stage kidney disease (ESKD) defined as estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m2, initiation of dialysis, or kidney transplantation; 2) Progression of albuminuria (from 0-30 mg/day to 30-300 mg/day or from 30-300 mg/day to >300 mg/day); 3) An eGFR decline ≥30%; 4) A composite kidney endpoint consisting of all three endpoints. Kaplan-Meier curves and Cox proportional hazard regression models were used.

Results

Among the 318 persons, the mean age was 56 years, 50% were men, and the median eGFR was 79 mL/min/1.73m2. During a median follow-up of 5.5 years, 3.5% met the ESKD endpoint, 6.3% progressed in albuminuria, 14.2% had a decline in eGFR ≥30%, and 21.1% met the composite kidney endpoint. The Kaplan-Meier curves showed no association between sclerostin or DKK1 and kidney disease progression, whereas OPG above median had a lower survival for all endpoints except for albuminuria progression (Figure 1). In unadjusted Cox regression models, sclerostin and DKK1 were significantly associated with ESKD, while OPG was significantly associated with all kidney endpoints except for eGFR decline ≥30%. After adjustment for age, gender, systolic blood pressure, diabetes duration, eGFR, and UACR, only OPG was significantly associated with the composite kidney endpoint (p=0.047).

Conclusion

In this prospective cohort study, OPG, but not sclerostin or DKK1, was associated with progression of CKD, and could have prognostic importance in patients with T1D.

Funding

  • Private Foundation Support