Baseline risk markers and visit-to-visit variability in relation to kidney outcomes - A post-hoc analysis of the PERL...

Area of Science:

• Nephrology
• Endocrinology
• Clinical Trials

Background:

• Diabetic kidney disease (DKD) is a major complication of type 1 diabetes (T1D).
• Identifying early risk markers for kidney function decline is crucial for timely intervention.
• Baseline risk variables and visit-to-visit variability (VV) in clinical parameters are potential predictors of DKD progression.

Purpose of the Study:

• To investigate the association between baseline risk variables and VV of key clinical parameters with kidney function decline in T1D.
• To identify novel, clinically feasible markers for risk stratification of DKD in T1D patients.

Main Methods:

• Post-hoc analysis of a randomized, placebo-controlled trial of allopurinol in T1D patients with elevated uric acid.
• Iohexol-derived glomerular filtration rate (iGFR) change over three years was the primary outcome.
• Linear regression models were used to identify baseline predictors and assess the impact of VV (systolic blood pressure, HbA1c, serum creatinine, uric acid) on iGFR change.

Main Results:

• Higher baseline HbA1c, systolic blood pressure (SBP), iGFR, albuminuria, heart rate, and mineralocorticoid receptor antagonist use were associated with greater iGFR decline.
• Increased visit-to-visit variability of SBP was significantly associated with a greater decline in iGFR (adjusted β: -0.79, p=0.01).
• 404 participants were included in the primary analyses.

Conclusions:

• Several baseline factors and, notably, SBP variability are identified as risk markers for accelerated kidney function decline in T1D.
• Visit-to-visit variability in SBP presents a potential new, clinically accessible measure for risk stratification of DKD.
• Further research is warranted to validate these findings and integrate them into clinical practice for T1D management.