Insa M Schmidt1, Anand Srivastava2, Venkata Sabbisetti3, Gearoid M McMahon3, Jiang He4, Jing Chen4, John W Kusek5, Jonathan Taliercio6, Ana C Ricardo7, Chi-Yuan Hsu8, Paul L Kimmel9, Kathleen D Liu8, Theodore E Mifflin5, Robert G Nelson10, Ramachandran S Vasan11, Dawei Xie5, Xiaoming Zhang5, Ragnar Palsson12, Isaac E Stillman13, Helmut G Rennke14, Harold I Feldman5, Joseph V Bonventre3, Sushrut S Waikar15. 1. Section of Nephrology, Department of Medicine, Boston University School of Medicine, Boston Medical Center Boston, Massachusetts; Renal Division, Brigham & Women's Hospital, Harvard Medical School Boston, Massachusetts. 2. Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 3. Renal Division, Brigham & Women's Hospital, Harvard Medical School Boston, Massachusetts. 4. Department of Epidemiology and Medicine, Tulane University School of Public Health and Tropical Medicine, Tulane University School of Medicine, New Orleans, Louisana. 5. Department of Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 7. Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois. 8. Division of Nephrology, University of California San Francisco School of Medicine, San Francisco, California. 9. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. 10. Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona. 11. Section of Preventive Medicine and Epidemiology, Boston University Boston, Massachusetts. 12. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 13. Department of Pathology, Beth Israel Deaconess Medical Center Boston, Massachusetts. 14. Pathology Department, Brigham & Women's Hospital, Boston, Massachusetts. 15. Section of Nephrology, Department of Medicine, Boston University School of Medicine, Boston Medical Center Boston, Massachusetts; Renal Division, Brigham & Women's Hospital, Harvard Medical School Boston, Massachusetts. Electronic address: swaikar@bu.edu.
Abstract
RATIONALE & OBJECTIVE: Plasma kidney injury molecule 1 (KIM-1) is a sensitive marker of proximal tubule injury, but its association with risks of adverse clinical outcomes across a spectrum of kidney diseases is unknown. STUDY DESIGN: Prospective, observational cohort study. SETTING & PARTICIPANTS: 524 individuals enrolled into the Boston Kidney Biopsy Cohort (BKBC) Study undergoing clinically indicated native kidney biopsy with biopsy specimens adjudicated for semiquantitative scores of histopathology by 2 kidney pathologists and 3,800 individuals with common forms of chronic kidney disease (CKD) enrolled into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE: Histopathologic lesions and clinicopathologic diagnosis in cross-sectional analyses, baseline plasma KIM-1 levels in prospective analyses. OUTCOMES: Baseline plasma KIM-1 levels in cross-sectional analyses, kidney failure (defined as initiation of kidney replacement therapy) and death in prospective analyses. ANALYTICAL APPROACH: Multivariable-adjusted linear regression models tested associations of plasma KIM-1 levels with histopathologic lesions and clinicopathologic diagnoses. Cox proportional hazards models tested associations of plasma KIM-1 levels with future kidney failure and death. RESULTS: In the BKBC Study, higher plasma KIM-1 levels were associated with more severe acute tubular injury, tubulointerstitial inflammation, and more severe mesangial expansion after multivariable adjustment. Participants with diabetic nephropathy, glomerulopathies, and tubulointerstitial disease had significantly higher plasma KIM-1 levels after multivariable adjustment. In the BKBC Study, CKD in 124 participants progressed to kidney failure and 85 participants died during a median follow-up time of 5 years. In the CRIC Study, CKD in 1,153 participants progressed to kidney failure and 1,356 participants died during a median follow-up time of 11.5 years. In both cohorts, each doubling of plasma KIM-1 level was associated with an increased risk of kidney failure after multivariable adjustment (hazard ratios of 1.19 [95% CI, 1.03-1.38] and 1.10 [95% CI, 1.06-1.15] for BKBC and CRIC, respectively). There was no statistically significant association of plasma KIM-1 levels with death in either cohort. LIMITATIONS: Generalizability and unmeasured confounding. CONCLUSIONS: Plasma KIM-1 is associated with underlying tubulointerstitial and mesangial lesions and progression to kidney failure in 2 cohort studies of individuals with kidney diseases.
RATIONALE & OBJECTIVE: Plasma kidney injury molecule 1 (KIM-1) is a sensitive marker of proximal tubule injury, but its association with risks of adverse clinical outcomes across a spectrum of kidney diseases is unknown. STUDY DESIGN: Prospective, observational cohort study. SETTING & PARTICIPANTS: 524 individuals enrolled into the Boston Kidney Biopsy Cohort (BKBC) Study undergoing clinically indicated native kidney biopsy with biopsy specimens adjudicated for semiquantitative scores of histopathology by 2 kidney pathologists and 3,800 individuals with common forms of chronic kidney disease (CKD) enrolled into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE: Histopathologic lesions and clinicopathologic diagnosis in cross-sectional analyses, baseline plasma KIM-1 levels in prospective analyses. OUTCOMES: Baseline plasma KIM-1 levels in cross-sectional analyses, kidney failure (defined as initiation of kidney replacement therapy) and death in prospective analyses. ANALYTICAL APPROACH: Multivariable-adjusted linear regression models tested associations of plasma KIM-1 levels with histopathologic lesions and clinicopathologic diagnoses. Cox proportional hazards models tested associations of plasma KIM-1 levels with future kidney failure and death. RESULTS: In the BKBC Study, higher plasma KIM-1 levels were associated with more severe acute tubular injury, tubulointerstitial inflammation, and more severe mesangial expansion after multivariable adjustment. Participants with diabetic nephropathy, glomerulopathies, and tubulointerstitial disease had significantly higher plasma KIM-1 levels after multivariable adjustment. In the BKBC Study, CKD in 124 participants progressed to kidney failure and 85 participants died during a median follow-up time of 5 years. In the CRIC Study, CKD in 1,153 participants progressed to kidney failure and 1,356 participants died during a median follow-up time of 11.5 years. In both cohorts, each doubling of plasma KIM-1 level was associated with an increased risk of kidney failure after multivariable adjustment (hazard ratios of 1.19 [95% CI, 1.03-1.38] and 1.10 [95% CI, 1.06-1.15] for BKBC and CRIC, respectively). There was no statistically significant association of plasma KIM-1 levels with death in either cohort. LIMITATIONS: Generalizability and unmeasured confounding. CONCLUSIONS: Plasma KIM-1 is associated with underlying tubulointerstitial and mesangial lesions and progression to kidney failure in 2 cohort studies of individuals with kidney diseases.
Authors: Insa M Schmidt; Suraj Sarvode Mothi; Parker C Wilson; Ragnar Palsson; Anand Srivastava; Ingrid F Onul; Zoe A Kibbelaar; Min Zhuo; Afolarin Amodu; Isaac E Stillman; Helmut G Rennke; Benjamin D Humphreys; Sushrut S Waikar Journal: Clin J Am Soc Nephrol Date: 2021-11-10 Impact factor: 8.237
Authors: Elion Hoxha; Anna Suling; Jan Eric Turner; Marion Haubitz; Jürgen Floege; Tobias B Huber; Jan-Christoph Galle Journal: Internist (Berl) Date: 2021-06-09 Impact factor: 0.743
Authors: Insa M Schmidt; Mia R Colona; Anand Srivastava; Guanghao Yu; Venkata Sabbisetti; Joseph V Bonventre; Sushrut S Waikar Journal: Kidney Med Date: 2022-06-02