Key result
Low plasma renin activity was independently associated with a more rapid decline in kidney function, showing a significantly larger annual decrease in eGFR (coefficient -4.410) compared to high renin activity.
Why the study?
Plasma renin activity is lower in patients with diabetic nephropathy than in healthy individuals, but its association with renal outcomes remains uncertain.
Is low plasma renin activity associated with faster decline in kidney function in patients with diabetic nephropathy?
Observational (n=97)
No
Is low plasma renin activity associated with faster decline in kidney function in patients with diabetic nephropathy?
Mean Difference: -4.41 (95% CI -7.91–-0.909)
Absolute Event Rate: -8.8% vs -3.1%
p-value: p=0.01
Low plasma renin activity is independently associated with more rapid kidney disease progression and worse renal outcomes in patients with diabetic nephropathy.
Low PRA associated with faster eGFR decline in diabetic nephropathy; hypothesis-generating and requires prospective validation before clinical use.
Plasma renin activity (PRA) is lower in patients with diabetic nephropathy (DN) than in healthy individuals. However, the association, if any, between PRA and renal outcomes in patients with DN remains uncertain. In a 2-year prospective observational study, we aimed to investigate the association of PRA with the decline in kidney function in patients with DN. We studied 97 patients with DN who were categorized according to tertile (T1–T3) of PRA. The annual changes in estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2/year) were determined from the slope of the linear regression curve for eGFR. The secondary endpoint was defined as a composite of the doubling of serum creatinine or end-stage renal disease. Results showed that kidney function rapidly declined with lower tertiles of PRA (median value [interquartile range] of the annual eGFR changes: –8.8 [–18.5 to –4.2] for T1, –8.0 [–14.3 to –3.2] for T2, and –3.1 [–6.3 to –2.0] for T3; p for trend <0.01). Multivariable linear regression analyses showed that, compared with T3, T1 was associated with a larger annual change in eGFR (coefficient, –4.410; 95% confidence interval [CI], –7.910 to –0.909 for T1). Composite renal events occurred in 46 participants. In multivariable Cox analysis, the lower tertiles of PRA (T1 and T2) were associated with higher incidences of the composite renal outcome (T2: hazard ratio [HR], 4.78; 95% CI, 1.64–13.89; T1: HR, 4.85; 95% CI 1.61–14.65) than T3. In conclusion, low PRA is independently associated with poor renal outcomes in patients with DN.
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Kuma et al. (2021) conducted an observational in Type 2 diabetes with overt nephropathy (n=97). Low plasma renin activity (Tertile 1) vs. High plasma renin activity (Tertile 3) was evaluated on Annual change in estimated glomerular filtration rate (eGFR) in mL/min/1.73 m2/year (Coefficient -4.410, 95% CI -7.910 to -0.909, p=0.01). Low plasma renin activity was independently associated with a more rapid decline in kidney function, showing a significantly larger annual decrease in eGFR (coefficient -4.410) compared to high renin activity.
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