Kidney Functional Magnetic Resonance Imaging and Change in eGFR in Individuals with CKD
Year: 2020
Type: article
Abstract: Background and objectives Kidney functional magnetic resonance imaging (MRI) requires further investigation to enhance the noninvasive identification of patients at high risk of CKD progression. Design, setting, participants, & measurements In this exploratory study, we obtained baseline diffusion-weighted and blood oxygen level–dependent MRI in 122 participants of the CKD Optimal Management with Binders and Nicotinamide trial, which was a multicenter, randomized, double-blinded, 12-month, four-group parallel trial of nicotinamide and lanthanum carbonate versus placebo conducted in individuals with eGFR 20–45 ml/min per 1.73 m 2 . Lower values of apparent diffusion coefficient (ADC) on diffusion-weighted MRI may indicate increased fibrosis, and higher values of relaxation rate (R2*) on blood oxygen level–dependent MRI may represent decreased oxygenation. Because there was no effect of active treatment on eGFR over 12 months, we tested whether baseline kidney functional MRI biomarkers were associated with eGFR decline in all 122 participants. In a subset of 87 participants with 12-month follow-up MRI data, we evaluated whether kidney functional MRI biomarkers change over time. Results Mean baseline eGFR was 32±9 ml/min per 1.73 m 2 , and mean annual eGFR slope was −2.3 (95% confidence interval [95% CI], −3.4 to −1.1) ml/min per 1.73 m 2 per year. After adjustment for baseline covariates, baseline ADC was associated with change in eGFR over time (difference in annual eGFR slope per 1 SD increase in ADC: 1.3 [95% CI, 0.1 to 2.5] ml/min per 1.73 m 2 per year, ADC×time interaction P =0.04). This association was no longer significant after further adjustment for albuminuria (difference in annual eGFR slope per 1 SD increase in ADC: 1.0 (95% CI, −0.1 to 2.2) ml/min per 1.73 m 2 per year, ADC×time interaction P =0.08). There was no significant association between baseline R2* and change in eGFR over time. In 87 participants with follow-up functional MRI, ADC and R2* values remained stable over 12 months (intraclass correlation: 0.71 and 0.68, respectively). Conclusions Baseline cortical ADC was associated with change in eGFR over time, but this association was not independent of albuminuria. Kidney functional MRI biomarkers remained stable over 1 year. Clinical Trial registry name and registration number CKD Optimal Management with Binders and Nicotinamide (COMBINE), NCT02258074.
DOI: 10.2215/cjn.13201019
Authors: Anand Srivastava, Xuan Cai, Jungwha Lee, Wei Li, Brett Larive, Cynthia Kendrick, Jennifer J. Gassman, John P. Middleton, James Carr, Kalani L. Raphael, Alfred K. Cheung, Dominic S. Raj, Michel B. Chonchol, Linda F. Fried, Geoffrey A. Block, Stuart M. Sprague, Myles Wolf, Joachim H. Ix, Pottumarthi V. Prasad, Tamara Isakova
Institutions: Northwestern University, Endeavor Health, Cleveland Clinic, Duke University, Duke Medical Center, University of Utah, VA Salt Lake City Healthcare System, University of Utah Health Care, George Washington University, University of Colorado Anschutz, University of Pittsburgh, VA Pittsburgh Healthcare System, Reata Pharmaceuticals (United States), University of San Diego, VA San Diego Healthcare System
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Baxter International, Northwestern University, National Institutes of Health, Feinberg School of Medicine, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences, Northwestern Medicine
Awards: G1496914557, G1647485984, G1663682336, G1860631916, G2684926809, G2886698120, G3425637028, Northwestern University Clinical and Translational Science Institute (NUCATS), Kidney Therapeutics: Translating Discoveries into Prevention, Treatment and Cures for Kidney Diseases, G606245974, Novel Diagnostics and Therapeutic Targets for Calcification in CKD, G7707125228, Pilot Studies Targeting Mineral Metabolism in Chronic Kidney Disease, Data Coordinating Center for Pilot Studies of Candidate Therapies for CKD, G9000025424, G9000028612, G9000049855, G9000139444, G9000236443, G9000257832, G9000289044
OpenAlex ID: W3020593100