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Prognostic value of metabolic syndrome in renal structural changes in type 2 diabetes

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Abstract

Purpose

To investigate the prognostic value of metabolic syndrome (MetS) and its relationship with renal structure changes in patients with type 2 diabetes and associated diabetic nephropathy (DN).

Methods

411 Chinese patients with type 2 diabetes and biopsy-confirmed DN were enrolled in this retrospective study. MetS was defined according to the modified criteria of the 2005 International Diabetes Federation. Baseline demographics and clinical information at the time of renal biopsy were extracted from the hospital’s electronic medical records system. Renal pathological findings were assessed according to Renal Pathology Society system. Univariate and multivariate logistic regression analyses were performed to define the pathological covariates associated with MetS. A competing risk model, with death as the competing risk, was used to estimate the sub-distribution hazard ratio (SHR) of MetS for end-stage kidney disease (ESKD).

Results

224 (55%) patients had MetS. Patients with MetS had poor renal function and more severe interstitial fibrosis tubular atrophy scores (IFTA) than those without MetS. Multivariate logistic regression analysis revealed that IFTA was significantly associated with MetS (odds ratio per score increase 1.45, 95% confidence interval [CI] 1.02–2.05). Of the patients with DN at risk, 40% of patients progressed to ESKD. After adjusting for renal function and pathological parameters, the presence of MetS was an independent predictor for progression to ESKD (SHR 1.93, 95% CI 1.34–2.79). The SHRs for progression to ESKD also increased as the number of MetS components increased. Additionally, adding the IFTA scores improved the prognostic power of a model that only contained MetS and clinical covariates for predicting future ESKD.

Conclusion

MetS is an independent prognostic predictor of ESKD in patients with T2D and DN, while adding the IFTA scores increased the prognostic value of MetS for renal outcome.

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Data availability

Datasets are available from the corresponding author on reasonable request.

Code availability

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Acknowledgements

This study was supported by the National Natural Science Foundation of China [Grant numbers 81970626 and 81670662]; Key Research and Development Project of Sichuan Science and Technology Department [Grant number 19ZDYF1273], Postdoctoral Research Foundation of Sichuan University [Grant number 2021SCU12029]. The funding source played no role in study design, data analysis, and manuscript writing or submission.

Funding

This study was supported by the National Natural Science Foundation of China [Grant numbers 81970626 and 81670662]; Key Research and Development Project of Sichuan Science and Technology Department [Grant number 19ZDYF1273], Postdoctoral Research Foundation of Sichuan University [Grant number 2021SCU12029]. The funding source played no role in study design, data analysis, and manuscript writing or submission.

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Authors and Affiliations

  1. Department of Nephrology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Lijun Zhao, Yutong Zou, Honghong Ren, Yucheng Wu, Yiting Wang, Yuancheng Zhao & Fang Liu

  2. Histology and Imaging Platform, Core Facility of West China Hospital, Chengdu, Sichuan, China

    Lin Bai, Li Zhou, Linqiao Tang & Jie Zhang

  3. Division of General Practice, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Shuangqing Li & Qiaoli Su

  4. Division of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Huan Xu & Lin Li

  5. Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia

    Zhonglin Chai & Mark E. Cooper

  6. Division of Endocrinology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China

    Nanwei Tong

  7. Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Lijun Zhao, Yutong Zou, Honghong Ren, Yucheng Wu, Yiting Wang, Yuancheng Zhao & Fang Liu

  8. Department of General Practice, West China Hospital of Sichuan University, Chengdu, Sichuan, China

    Lijun Zhao

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  1. Lijun Zhao
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  2. Yutong Zou
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  3. Lin Bai
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  4. Li Zhou
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  5. Honghong Ren
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Contributions

All authors participated in the conceive, design of the manuscript. All authors have read and approved the final manuscript; LZ analyzed the data, interpreted the results and drafted the manuscript. FL analyzed and interpreted data, edited/revised the manuscript. FL and NT approved the final version of the manuscript. HX and LL performed pathological reviewing. HR, YZ, YW, YZ, YW carried out the data collecting and recording. ZC, MEC, NT, JZ, LB, LZ, LT, QS, and SL contributed to the discussion. FL is the guarantor of this work and had full access to all the data in this study, and takes responsibility for the integrity of the data.

Corresponding authors

Correspondence to Nanwei Tong or Fang Liu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board at the West China Hospital of Sichuan University.

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Zhao, L., Zou, Y., Bai, L. et al. Prognostic value of metabolic syndrome in renal structural changes in type 2 diabetes. Int Urol Nephrol 54, 2005–2014 (2022). https://doi.org/10.1007/s11255-021-03051-x

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