Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease.

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Version: Final published version
Serval ID
serval:BIB_13E0FF52CCA9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease.
Journal
Kidney international
Author(s)
Pruijm M., Milani B., Pivin E., Podhajska A., Vogt B., Stuber M., Burnier M.
ISSN
1523-1755 (Electronic)
ISSN-L
0085-2538
Publication state
Published
Issued date
04/2018
Peer-reviewed
Oui
Volume
93
Number
4
Pages
932-940
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Renal tissue hypoxia is a final pathway in the development and progression of chronic kidney disease (CKD), but whether renal oxygenation predicts renal function decline in humans has not been proven. Therefore, we performed a prospective study and measured renal tissue oxygenation by blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) in 112 patients with CKD, 47 with hypertension without CKD, and 24 healthy control individuals. Images were analyzed with the twelve-layer concentric objects method that divided the renal parenchyma in 12 layers of equal thickness and reports the mean R2* value of each layer (a high R2* corresponds to low oxygenation), along with the change in R2* between layers called the R2* slope. Serum creatinine values were collected to calculate the yearly change in estimated glomerular function rate (MDRD eGFR). Follow up was three years. The change in eGFR in CKD, hypertensive and control individuals was -2.0, 0.5 and -0.2 ml/min/1.73m <sup>2</sup> /year, respectively. In multivariable regression analysis adjusted for age, sex, diabetes, RAS-blockers, eGFR, and proteinuria the yearly eGFR change correlated negatively with baseline 24 hour proteinuria and the mean R2* value of the cortical layers, and positively with the R2* slope, but not with the other covariates. Patients with CKD and high outer R2* or a flat R2* slope were three times more likely to develop an adverse renal outcome (renal replacement therapy or over a 30% increase in serum creatinine). Thus, low cortical oxygenation is an independent predictor of renal function decline. This finding should stimulate studies exploring the therapeutic impact of improving renal oxygenation on renal disease progression.
Keywords
Adult, Aged, Biomarkers/blood, Case-Control Studies, Cell Hypoxia, Creatinine/blood, Disease Progression, Female, Glomerular Filtration Rate, Humans, Kidney Cortex/diagnostic imaging, Kidney Cortex/metabolism, Kidney Cortex/physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Oxygen/metabolism, Oxygen Consumption, Predictive Value of Tests, Prospective Studies, Renal Insufficiency, Chronic/diagnostic imaging, Renal Insufficiency, Chronic/metabolism, Renal Insufficiency, Chronic/physiopathology, Renal Insufficiency, Chronic/therapy, Renal Replacement Therapy, Reproducibility of Results, Risk Assessment, Risk Factors, Time Factors, BOLD-MRI, chronic kidney disease, hypoxia, proteinuria, renal function decline
Pubmed
Web of science
Open Access
Yes
Create date
27/01/2018 9:58
Last modification date
20/08/2019 12:42
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