Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China.
Department of Nephrology, The Third People's Hospital of Chengdu, Chengdu 610014, China.
Nutrients. 2022 Sep 2;14(17):3634. doi: 10.3390/nu14173634.
Malnutrition and immunologic derangement were not uncommon in patients with chronic kidney disease (CKD). However, the long-term effects of prognostic nutritional index (PNI), an immunonutrition indictor, on renal outcomes in patients with diabetic nephropathy (DN) and type 2 diabetes mellitus (T2DM) are unknown. In this retrospective cohort study, 475 patients with T2DM and biopsy-confirmed DN from West China Hospital between January 2010 and September 2019 were evaluated. PNI was evaluated as serum albumin (g/L) + 5 × lymphocyte count (109/L). The study endpoint was defined as progression to end-stage renal disease (ESRD). The Cox regression analysis was performed to investigate the risk factors of renal failure in DN patients. A total of 321 eligible individuals were finally included in this study. The patients with higher PNI had a higher eGFR and lower proteinuria at baseline. Correlation analysis indicated PNI was positively related eGFR (r = 0.325, p < 0.001), and negatively correlated with proteinuria (r = −0.68, p < 0.001), glomerular lesion (r = −0.412, p < 0.001) and interstitial fibrosis and tubular atrophy (r = −0.282, p < 0.001). During a median follow-up of 30 months (16−50 months), the outcome event occurred in 164(51.09%) of all the patients. After multivariable adjustment, each SD (per-SD) increment of PNI at baseline was associated with a lower incidence of ESRD (hazard ratio, 0.705, 95% CI, 0.523−0.952, p = 0.023), while the hypoalbuminemia and anemia were not. For the prediction of ESRD, the area under curves (AUC) evaluated with time-dependent receiver operating characteristics were 0.79 at 1 year, 0.78 at 2 years, and 0.74 at 3 years, respectively, and the addition of PNI could significantly improve the predictive ability of the model incorporating traditional risk factors. In summary, PNI correlated with eGFR and glomerular injury and was an independent predictor for DN progression in patients with T2DM. Thus, it may facilitate the risk stratification of DN patients and contribute to targeted management.
营养不良和免疫功能紊乱在慢性肾脏病（CKD）患者中并不少见。然而，预后营养指数（PNI）作为一种免疫营养指标，对糖尿病肾病（DN）和 2 型糖尿病（T2DM）患者的肾脏结局的长期影响尚不清楚。在这项回顾性队列研究中，对 2010 年 1 月至 2019 年 9 月期间来自华西医院的 475 例 T2DM 合并活检证实的 DN 患者进行了评估。PNI 评估为血清白蛋白（g/L）+5×淋巴细胞计数（109/L）。研究终点定义为进展为终末期肾病（ESRD）。采用 Cox 回归分析探讨 DN 患者肾功能衰竭的危险因素。最终共有 321 名符合条件的个体纳入本研究。基线时，PNI 较高的患者具有更高的 eGFR 和更低的蛋白尿。相关性分析表明，PNI 与 eGFR 呈正相关（r=0.325，p<0.001），与蛋白尿（r=-0.68，p<0.001）、肾小球病变（r=-0.412，p<0.001）和间质纤维化和肾小管萎缩（r=-0.282，p<0.001）呈负相关。在中位随访 30 个月（16-50 个月）期间，所有患者中有 164 例（51.09%）发生了结局事件。多变量调整后，基线时 PNI 每增加 1 个标准差（per-SD）与 ESRD 的发生率降低相关（风险比，0.705，95%CI，0.523-0.952，p=0.023），而低白蛋白血症和贫血则不然。对于 ESRD 的预测，基于时间依赖性接受者操作特征的曲线下面积（AUC）分别在 1 年、2 年和 3 年时为 0.79、0.78 和 0.74，而加入 PNI 可显著提高包含传统危险因素的模型的预测能力。总之，PNI 与 eGFR 和肾小球损伤相关，是 T2DM 患者 DN 进展的独立预测因素。因此，它可能有助于对 DN 患者进行风险分层，并有助于进行有针对性的管理。
