Intrinsic Capacity, Obesity Predict Kidney Disease in T2D

08/04/2022

Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

Older patients (65 years and older) with type 2 diabetes and decreased intrinsic capacity (a measure of physical and mental robustness) were more likely to have elevated risk for chronic kidney disease (CKD), especially if they also had obesity, particularly sarcopenic obesity (obesity with reduced muscle mass and strength).

Why This Matters

Screening older adults with type 2 diabetes for impaired intrinsic capacity plus obesity could identify people at high risk of CKD even before changes in the usual measures of renal function that denote onset of CKD: urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and serum creatinine levels.
The authors called for earlier interventions for intrinsic capacity impairment and obesity in older individuals with type 2 diabetes to help prevent incident CKD.

Study Design

The researchers included 2482 patients aged 65-99 years with type 2 diabetes and were otherwise healthy with no indications of having nondiabetic renal disease who received their initial diabetes diagnosis at any of nine Taiwan diabetes clinics during 2006-2021.
The researchers determined each participant’s intrinsic capacity with the ICOPE (WHO) screening tools, including six functional assessments of these five domains: locomotion, cognition, vitality, sensory (visual and sensory), and psychological symptoms. They scored patients with a point for each of the five domains that showed impairment.
The researchers defined obesity by the body mass index (BMI) criteria for residents of Taiwan:
- Underweight: < 18.5 kg/m²
- Normal weight: 18.5 to < 24
- Overweight: 24 to < 27
- Mild obesity: 27 to <30
- Moderate obesity: 30 to < 35
- Severe obesity: > 35
Assessment of CKD risk depended on both eGFR and UACR, and the researchers used these parameters and the 2012 criteria of the Kidney Disease: Improving Global Outcomes program to classify subjects into one of four CDK risk strata: low, moderately increased, high, and very high.

Key Results

Enrolled subjects (mean age 72) had type 2 diabetes for an average of 14 years. Their mean eGFR was 69 mL/min/1.73 m² and their median UACR was 19 mg/g.
Most patients had an intrinsic capacity score of 0 (61.4%) or 1 (26.4%), but 12.2% had an intrinsic capacity score of 2 to 5. More of the subjects with scores of 2-5 were women, and more had severe obesity, high, or very high risk of CKD, and higher rates of both insulin and oral hypoglycemic agent use, and they were also older and had longer diabetes duration, compared with those with an intrinsic capacity score of 0 or 1.
In multivariate analysis, those with an intrinsic capacity score of 2-5 had a significant 76% higher rate of having a moderately increased to very high risk of CKD compared with patients with an intrinsic capacity score of 0. The level of CKD risk did not significantly differ between those with an intrinsic capacity score of 1 and those with a score of 2-5.
Analysis also showed a synergistic, positive interaction between intrinsic capacity score and obesity on the rate of CKD. Subjects with an intrinsic capacity score of 1-5 and moderate or severe obesity had a significant, 2.71-fold increased rate of CKD risk compared with those with an intrinsic capacity score of 0 and no obesity.

Limitations

The researchers lacked data on inflammation, adipocytokines, and other specific kidney injury markers, and they said that further studies should examine the associations between these parameters and intrinsic capacity and the progression of CKD in people with type 2 diabetes.
The study had an inadequate number of subjects to allow for a meaningful assessment of which of the five components of the intrinsic capacity impairment score have the strongest links with CKD.
This was a preliminary, cross-sectional association study and it cannot show how intrinsic capacity relates to the progression of CKD over time.

Disclosures

The study did not receive commercial funding.
The authors report no financial disclosures.

This is a summary of a preprint research study, “Interactive effects of intrinsic capacity and obesity on the risk of chronic kidney disease in older patients with type 2 diabetes mellitus” written by researchers at various institutions in Taiwan (Republic of China) on Research Square, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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