Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Ren Fail. 2024 Dec;46(1):2295425. doi: 10.1080/0886022X.2023.2295425. Epub 2024 Jan 4.
Hook F (TwHF) has been shown to substantially reduce proteinuria in patients with diabetic kidney disease (DKD); however, the effect of TwHF on renal outcomes in DKD remains unknown. Accordingly, we aimed to establish the effects of TwHF on renal outcomes in patients with DKD.
Overall, 124 patients with DKD, induced by type 2 diabetes mellitus, with 24-h proteinuria > 2 g, and an estimated glomerular filtration rate > 30 mL/min/1.73 m were retrospectively investigated. The renal outcomes were defined as doubling serum creatinine levels or end-stage kidney disease. Kaplan-Meier curves and Cox regression analyses were performed to analyze prognostic factors for renal outcomes.
By the end of the follow-up, renal outcomes were observed in 23 and 11 patients in the non-TwHF and TwHF groups, respectively ( = 0.006). TwHF significantly reduced the risk of renal outcomes (adjusted hazard ratio [HR] 0.271, 95% confidence interval [CI] 0.111-0.660, = 0.004) in patients with chronic kidney disease (CKD) G3 (adjusted HR 0.274, 95%CI 0.081-0.932, = 0.039). Based on the Kaplan-Meier analysis, 1- and 3-year proportions of patients without renal outcomes were significantly lower in the non-TwHF group than those in the TwHF group (92.8% vs. 95.5% and 47.2% vs. 76.8%, respectively; = 0.0018).
In DKD patients with severe proteinuria, TwHF could prevent DKD progression, especially in patients with CKD G3. A randomized clinical trial is needed to elucidate the benefits of TwHF on renal outcomes in patients with DKD.
钩端螺旋体丝状血凝素（TwHF）已被证明可显著减少糖尿病肾病（DKD）患者的蛋白尿；然而，TwHF 对 DKD 患者肾脏结局的影响尚不清楚。因此，我们旨在确定 TwHF 对 DKD 患者肾脏结局的影响。
共回顾性分析了 124 例由 2 型糖尿病引起的 DKD 患者，24 小时蛋白尿>2g，估算肾小球滤过率>30ml/min/1.73m2。肾脏结局定义为血清肌酐水平翻倍或终末期肾病。采用 Kaplan-Meier 曲线和 Cox 回归分析来分析肾脏结局的预测因素。
随访结束时，非 TwHF 组和 TwHF 组分别有 23 例和 11 例患者出现肾脏结局（=0.006）。TwHF 显著降低了慢性肾脏病（CKD）G3 患者肾脏结局的风险（调整后的危险比[HR]0.271，95%置信区间[CI]0.111-0.660，=0.004）。基于 Kaplan-Meier 分析，非 TwHF 组和 TwHF 组在 1 年和 3 年时无肾脏结局的患者比例显著低于 TwHF 组（92.8%比 95.5%和 47.2%比 76.8%；=0.0018）。
在严重蛋白尿的 DKD 患者中，TwHF 可预防 DKD 进展，尤其是在 CKD G3 患者中。需要进行随机临床试验来阐明 TwHF 对 DKD 患者肾脏结局的益处。
