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Published on: October 13, 2023
Plasma D-dimer as a potential predictor of progression in IgA nephropathy: a cohort study
Guizhen Yu1, Yan Jiang1, Zishu Xu2
1Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; the Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China.
Insights
Elevated plasma D-dimer levels indicate coagulation activation and are linked to worsening kidney disease in IgA nephropathy (IgAN). Higher D-dimer levels significantly increase the risk of kidney disease progression in IgAN patients.
Area of Science:
- Nephrology
- Hematology
- Internal Medicine
Background:
- Coagulation disorders are implicated in chronic kidney disease (CKD) progression.
- Plasma D-dimer levels reflect coagulation system activation, but their role in IgA nephropathy (IgAN) severity and progression is not well-defined.
Purpose of the Study:
- To investigate the association between plasma D-dimer levels and the risk of kidney disease progression in patients with IgA nephropathy.
Main Methods:
- A cohort of 1818 IgAN patients was assessed, with plasma D-dimer levels measured at renal biopsy.
- Kidney disease progression was defined as a 50% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease (ESKD).
- Restricted cubic splines and Cox proportional hazard models were used to analyze the association between D-dimer levels and progression events.
Main Results:
- Plasma D-dimer levels were higher in IgAN patients compared to healthy controls and correlated positively with proteinuria and serum galactose-deficient IgA1.
- D-dimer levels negatively correlated with eGFR and Oxford T and C scores.
- Higher plasma D-dimer levels were significantly associated with an increased risk of kidney disease progression events, even after adjusting for clinical and pathological factors.
Conclusions:
- Elevated plasma D-dimer levels are a significant risk factor for kidney disease progression in IgA nephropathy.
- Plasma D-dimer may serve as a valuable biomarker for predicting disease severity and outcomes in IgAN.
Introduction:
Coagulation disorders play a key role in chronic kidney disease, and the formation or elevation of plasma D-dimer levels reflects activation of the coagulation system. However, its relationship with the severity and progression of kidney disease in IgA nephropathy (IgAN) remains unclear.
Methods:
We assessed 1818 patients with IgAN diagnosed between 2002 and 2019 at the First Affiliated Hospital, Zhejiang University School of Medicine. Plasma D-dimer levels were measured at the time of the renal biopsy. The association between plasma D-dimer levels and kidney disease progression events, defined as a 50% decline in eGFR and end-stage kidney disease (ESKD), was tested using restricted cubic splines and Cox proportional hazard models.
Results:
The median plasma D-dimer level was 220 (170-388.5) µg/L FEU, which was significantly higher than healthy controls 170 (170-202) µg/L FEU. Plasma D-dimer levels were positively correlated with proteinuria (r = 0.211, p < 0.001) and serum galactose-deficient IgA1 (r = 0.226, p = 0.004) and negatively correlated with eGFR (r=-0.127, p < 0.001) and Oxford T (p < 0.001) and C (p = 0.004) scores. After a median follow-up of 25.67 (13.03-47.44) months, 126 (6.93%) patients experienced composite kidney disease progression events. Higher plasma D-dimer levels were associated with an increased risk of kidney disease progression events (hazard ratio, 1.73; 95% confidence interval [95% CI], 1.40-2.23) per ln-transformed plasma D-dimer (p < 0.001), after adjustment for sex, age, proteinuria, Mean arterial pressure (MAP) and Oxford classification scores. In reference to the first tertile of plasma D-dimer, hazard ratios were 1.48 (95% CI, 0.76-2.88) for the second tertile, 3.03 (95% CI, 1.58-5.82) for the third tertile.
Conclusions:
High plasma D-dimer levels were associated with the progression of kidney disease severity in IgA nephropathy.
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