Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Ren Fail. 2023;45(2):2285868. doi: 10.1080/0886022X.2023.2285868. Epub 2023 Nov 27.
This study aimed to investigate the relationship between plasma D-dimer levels, clinicopathological features, and clinical outcomes in patients with biopsy-proven diabetic nephropathy (DN).
A total of 137 patients with biopsy-proven DN were enrolled in this two-center cohort study. Patients were stratified into tertiles based on plasma D-dimer levels. We investigated the relationship between plasma D-dimer levels and clinical outcomes, including a composite of death, a 40% decline in estimated glomerular filtration rate (e-GFR) from baseline, or end-stage renal disease (ESRD) (defined as e-GFR < 15 mL/min/1.73 m or need for renal replacement therapy including hemodialysis, peritoneal dialysis, or kidney transplantation), assessed using Cox regression models with adjustment for confounders.
At baseline, the mean age was 52.61 ± 11.63 years, and the mean e-GFR was 58.02 ± 28.77 mL/min/1.73 m. During a median 26-month follow-up period, 65 (47% of patients) achieved clinical outcomes. Compared with the low plasma D-dimer level group, those with higher plasma D-dimer levels were more likely to have higher 24-h proteinuria ( = .002), lower e-GFR ( = .001), lower hemoglobin ( = .001), a higher glomerular lesion class ( = .03), and higher interstitial fibrosis and tubular atrophy (IFTA) scores ( = .002). After adjustment for demographic, DN-specific covariates, and treatments, it was observed that a higher tertile of plasma D-dimer was nonlinearly associated with an increased risk of the clinical outcomes (Hazard Ratio (HR) for tertile 2 vs. 1, 1.7; 95% Confidence Interval (CI), 0.80-3.75; HR for tertile 3 vs. 1, 2.2; 95% CI, 0.93-5.27; for trend = .001) in the Cox proportional hazards models.
In this study, DN patients with higher levels of plasma D-dimer had higher 24-h proteinuria, lower e-GFR, a higher glomerular lesion class, and higher IFTA scores. Furthermore, a high level of plasma D-dimer was nonlinearly associated with DN progression.
本研究旨在探讨经活检证实的糖尿病肾病（DN）患者血浆 D-二聚体水平与临床病理特征和临床结局之间的关系。
本研究共纳入了 137 名经活检证实的 DN 患者，这些患者被分为三个血浆 D-二聚体水平组。我们采用 Cox 回归模型，通过调整混杂因素，调查了血浆 D-二聚体水平与临床结局（包括死亡、估算肾小球滤过率（e-GFR）从基线下降 40%、终末期肾病（ESRD）的复合终点，定义为 e-GFR < 15 mL/min/1.73 m 或需要肾脏替代治疗，包括血液透析、腹膜透析或肾移植）之间的关系。
在基线时，患者的平均年龄为 52.61 ± 11.63 岁，平均 e-GFR 为 58.02 ± 28.77 mL/min/1.73 m。在中位 26 个月的随访期间，有 65 名（占患者的 47%）发生了临床结局。与低血浆 D-二聚体水平组相比，高血浆 D-二聚体水平组的 24 小时蛋白尿更多（=.002），e-GFR 更低（=.001），血红蛋白更低（=.001），肾小球病变分级更高（=.03），间质纤维化和肾小管萎缩（IFTA）评分更高（=.002）。在调整人口统计学、DN 特异性协变量和治疗因素后，观察到血浆 D-二聚体三分位的较高水平与临床结局风险的增加呈非线性相关（三分位 2 与 1 相比的风险比（HR），1.7；95%置信区间（CI），0.80-3.75；三分位 3 与 1 相比的 HR，2.2；95%CI，0.93-5.27；趋势=.001）。
在这项研究中，血浆 D-二聚体水平较高的 DN 患者的 24 小时蛋白尿更多，e-GFR 更低，肾小球病变分级更高，IFTA 评分更高。此外，高血浆 D-二聚体水平与 DN 进展呈非线性相关。
