ホシノ　ジユンイチ   Hoshino Jiyun'ichi   星野　純一    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Polar vasculosis is associated with better kidney outcome in type 2 diabetes with biopsy-proven diabetic kidney disease: A multicenter cohort study.
掲載誌名	正式名：Journal of diabetes investigation 略　 称：J Diabetes Investig ISSNコード：20401124/20401116
巻・号・頁	14(11),pp.1268-1278
著者・共著者	Shimizu Miho, Furuichi Kengo, Toyama Tadashi, Yamanouchi Masayuki, Hoshino Junichi, Kitajima Shinji, Hara Akinori, Iwata Yasunori, Sakai Norihiko, Yuzawa Yukio, Kitamura Hiroshi, Sato Hiroshi, Shibagaki Yugo, Suzuki Yoshiki, Uesugi Noriko, Ueda Yoshihiko, Kohagura Kentaro, Samejima Kenichi, Tsuruya Kazuhiko, Nishi Shinichi, Nishino Tomoya, Makino Hirofumi, Matsuo Seiichi, Ubara Yoshifumi, Yokoyama Hitoshi, Wada Takashi,
発行年月	2023/11/14
概要	AIMS/INTRODUCTION:This multicenter cohort study retrospectively assessed the association between polar vasculosis and the progression of diabetic kidney disease (DKD) in type 2 diabetes.MATERIALS AND METHODS:We enrolled 811 patients with type 2 diabetes, biopsy-proven DKD, and proteinuria (≥0.15 g/g creatinine [g/day]). The association between polar vasculosis and other kidney lesions was explored. The outcome was DKD progression defined as a composite of renal replacement therapy initiation or 50% decline in estimated glomerular filtration rate (eGFR) from baseline.RESULTS:Of the 811 cases, 677 (83.5%) had polar vasculosis. In multivariate logistic regression analysis, subendothelial widening of the glomerular basement membrane, glomerulomegaly, glomerular class in the Renal Pathology Society classification ≥IIb, vascular lesions, age, eGFR, and hemoglobin A1c were positively associated with polar vasculosis, whereas interstitial fibrosis and tubular atrophy (IFTA) was negatively associated with polar vasculosis. During a median follow-up of 5.2 years, progression of DKD occurred in 322 of 677 (7.4 events/100 person-years) and 79 of 134 (11.4 events/100 person-years) cases with and without polar vasculosis, respectively. Kaplan-Meier analysis showed that polar vasculosis was associated with lower cumulative incidences of DKD progression. Multivariate Cox regression analyses showed that polar vasculosis was associated with a lower risk of DKD progression, regardless of eGFR or proteinuria subgroups. These associations between polar vasculosis and better kidney outcome were unchanged considering all-cause mortality before DKD progression as a competing event.CONCLUSIONS:This study showed that polar vasculosis of DKD was associated with less advanced IFTA and a better kidney outcome in type 2 diabetes with proteinuria.
DOI	10.1111/jdi.14059
PMID	37483063