Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Diabetes and Lifestyle-Related Disease Center, Tomishiro Central Hospital, Okinawa, Japan.
Sci Rep. 2021 Jun 3;11(1):11753. doi: 10.1038/s41598-021-88285-6.
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) may be linked to development of chronic kidney diseases (CKD). The FIB4 index, a noninvasive liver fibrosis score, has been reported to predict CKD in non-diabetic patients, but there are no reports yet in diabetic cases. Therefore, we evaluated the prognostic impact of FIB4 index on the risk of developing diabetic kidney disease (DKD) in Japanese patients with type 2 diabetes in a retrospective cohort study. We assessed patients with type 2 diabetes with an eGFR ≥ 60 mL/min/1.73 m and without dipstick positive proteinuria (≥ 1 +) at their first visit to our department. Participants were divided into two groups based on the FIB4 index at their first visit: FIB4 index > 1.3 and FIB4 index ≤ 1.3. The primary endpoint was defined as a decrease in eGFR < 60 mL/min/1.73 m or the onset of proteinuria during the course of treatment. The average age of all 584 type 2 diabetic participants (360 [61.6%] men) was 55 ± 11 years. There were 187 patients in the FIB4 index group > 1.3 (32.0%) and the median observation period was 6.0 (3.8-11.0) years. Kaplan-Meier survival analysis indicated that the risks of developing DKD, eGFR < 60 and proteinuria were all higher in FIB4 index > 1.3 patients than in FIB4 ≤ 1.3 patients. In the Cox regression analysis, an FIB4 index > 1.3 was a significant predictor for onset of DKD (HR 1.54, 95% CI 1.15-2.08) and proteinuria (HR 1.55, 95% CI 1.08-2.23), but not for an eGFR < 60 (HR 1.14, 95% CI 0.79-1.99). To the best of our knowledge, this is the first study to demonstrate that an FIB4 index > 1.3 has a prognostic impact on the development of CKD and proteinuria in type 2 diabetic patients. This warrants further investigation of the prognostic impact of the development of DKD or proteinuria.
非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）可能与慢性肾脏病（CKD）的发展有关。FIB4 指数是一种非侵入性的肝纤维化评分，已被报道可预测非糖尿病患者的 CKD，但在糖尿病患者中尚无报道。因此，我们在一项回顾性队列研究中评估了 FIB4 指数对日本 2 型糖尿病患者发生糖尿病肾病（DKD）风险的预后影响。我们评估了首次就诊时 eGFR≥60mL/min/1.73m 且尿试纸蛋白阳性（≥1+）阴性的 2 型糖尿病患者。根据首次就诊时的 FIB4 指数，将患者分为两组：FIB4 指数>1.3 和 FIB4 指数≤1.3。主要终点定义为 eGFR<60mL/min/1.73m 下降或治疗过程中蛋白尿的发生。所有 584 名 2 型糖尿病患者（360 [61.6%] 名男性）的平均年龄为 55±11 岁。FIB4 指数组>1.3 的患者有 187 例（32.0%），中位观察期为 6.0（3.8-11.0）年。Kaplan-Meier 生存分析表明，FIB4 指数>1.3 的患者发生 DKD、eGFR<60 和蛋白尿的风险均高于 FIB4≤1.3 的患者。在 Cox 回归分析中，FIB4 指数>1.3 是 DKD 发病（HR 1.54，95%CI 1.15-2.08）和蛋白尿（HR 1.55，95%CI 1.08-2.23）的显著预测因素，但不是 eGFR<60（HR 1.14，95%CI 0.79-1.99）的预测因素。据我们所知，这是第一项表明 FIB4 指数>1.3 对 2 型糖尿病患者 CKD 和蛋白尿发展具有预后影响的研究。这需要进一步研究 DKD 或蛋白尿发展的预后影响。
