Association of CT-based perirenal structural characteristics with chronic kidney disease risk categories: the...

Chronic kidney disease (CKD) is a major complication of type 2 diabetes mellitus (T2DM), yet diagnosis remains challenging. This study investigated whether perirenal structural features on CT offer diagnostic value for identifying T2DM patients at higher CKD risk.

494 T2DM patients who underwent plain abdominal CT were enrolled from 2 institutions. Patients were stratified into lower or higher CKD risk categories per KDIGO 2012 guidelines. The grade of perirenal fat stranding, fascia thickening, perirenal fat thickness, and Mayo adhesive probability were evaluated. Predictors were selected via Lasso and logistic regression to build clinical, imaging, and combined nomogram models.

Perirenal fat stranding (grade 2) and fascia thickening constituted the imaging model for higher CKD risk, while systolic blood pressure and haemoglobin formed the clinical model. The nomogram incorporating these 4 factors achieved concordance indices of 0.888 (95% CI: 0.850-0.927), 0.830 (95% CI: 0.731-0.929), and 0.791 (95% CI: 0.681-0.900) in the training, internal, and external validation sets, respectively, for identifying T2DM patients at increased CKD risk.

T2DM patients exhibiting perirenal fat stranding and fascia thickening should be identified as being at higher CKD risk. Further renal function tests are recommended to detect abnormalities early and be integrated promptly into standardised CKD management protocols.