1115-OR: Arteriolar Hyalinosis Predicts Long-Term EGFR Decline after Renal Biopsy in Persons with Type 2 Diabetes: A 21±6-Year Follow-Up Study

Introduction and Objective: Previously, we reported that renal arteriolar hyalinosis (AH) predicted the onset of macroalbuminuria prior to the onset of eGFR<60 ml/min/1.73m2 in persons with type 2 diabetes. However, it remains unclear which renal histological or functional parameters predict eGFR decline (eGFR slope) in long standing normo-microalbuminuric person with type 2 diabetes. Methods: Thirty-three persons with type 2 diabetes (23 men; age, 47±10 years; eGFR, 93.2±18.5 mL/min/1.73 m2, 18 normoalbuminuria (NA), and 15 microalbuminuria (MA)) who underwent percutaneous renal biopsy were followed at an outpatient clinic during an observation period of 21±6 year. We evaluated the eGFR slope and the annual change in albuminuria during follow-up. Light and electron microscopy-based morphometric analyses were performed to quantitatively evaluate glomerular and interstitial structural changes. Results: All study subjects had typical histological changes of DKD. The eGFR slope was significantly associated only with the index of AH (IAH; r=0.585, p=0.000), and not with any other histological parameters. In addition, baseline albuminuria did not predict the eGFR slope, and the eGFR slope was not different between NA and MA groups. On the other hand, IAH was significantly correlated with the slope of albuminuria increase (r=0.505, p=0.003). The slope of albuminuria increase was strongly correlated with slope of eGFR decline (r=0.733, p<0.001). Multiple regression analysis demonstrated that only IAH independently predicted the eGFR slope after renal biopsy (p=0.001), whereas baseline albuminuria, HbA1c, or mesangial expansion did not. Conclusion: Increased AH was the only predictor of progressive renal functional decline, independent of other renal histological or functional parameters, in persons with long-standing NA and MA type 2 diabetes. Further studies are needed to identify serological biomarkers that can predict renal functional decline beyond renal structural findings in clinical practice. Disclosure T. Moriya: None. A. Suzuki: None. A. Hayashi: Speaker's Bureau; Ended; Abbott Japan Co., Ltd., Dexcom, Inc., Medtronic, Novo Nordisk, Roche Diabetes Care, Sanwa Kagaku Kenkyusho. T. Miyatsuka: Advisory Panel; Current; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Advisory Panel; Current; Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk, Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Sumitomo Pharma, Tanabe Pharma.