Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients

Introduction: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is the angle of vector determined by the body’s resistance and reactance. It indicates cellular integrity and hydration status. Though extracellular volume excess was associated with chronic kidney disease (CKD) pr...

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Main Authors: Low, Serena, Pek, Sharon Li Ting, Moh, Angelia Mei Chung, Khoo, Jonathon, Ang, Keven, Tang, Wern Ee, Lim, Ziliang, Subramaniam, Tavintharan, Sum, Chee Fang, Lim, Su Chi
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2024
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Online Access:https://hdl.handle.net/10356/174030
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spelling sg-ntu-dr.10356-1740302024-03-17T15:38:37Z Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients Low, Serena Pek, Sharon Li Ting Moh, Angelia Mei Chung Khoo, Jonathon Ang, Keven Tang, Wern Ee Lim, Ziliang Subramaniam, Tavintharan Sum, Chee Fang Lim, Su Chi Lee Kong Chian School of Medicine (LKCMedicine) Khoo Teck Puat Hospital National University of Singapore Admiralty Medical Centre Medicine, Health and Life Sciences Bio-impedance analysis Chronic kidney disease Introduction: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is the angle of vector determined by the body’s resistance and reactance. It indicates cellular integrity and hydration status. Though extracellular volume excess was associated with chronic kidney disease (CKD) progression, the association between PhA and CKD progression is unknown. Matrix metalloproteinase-2 (MMP-2) is a member of zinc-dependent endopeptidase family and promotes renal interstitial fibrosis. We investigated association between PhA and CKD progression, and whether the association was through MMP-2 in patients with type 2 diabetes mellitus (T2DM). Method: We conducted a prospective study on 1,078 patients with T2DM (mean age 58.9±9.1 years). PhA was measured using BIA. CKD progression was defined as ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline with deterioration across eGFR categories. Multiplex immunoassay was used to quantitate MMP-2. We examined association between PhA and CKD progression using Cox proportional hazards model, adjusting for demographics, clinical parameters and medications. Results: Over 8.6 years of follow-up, 43.7% of participants had CKD progression. Compared to tertile 3 PhA (higher level), tertiles 1 and 2 PhA were associated with higher hazards of CKD progression, with corresponding unadjusted hazard ratios (HRs) of 2.27 (95% confidence interval [CI] 1.80–2.87, P<0.001) and 1.57 (95% CI 1.24–2.01, P<0.001). The positive association between tertiles 1 and 2 PhA with CKD progression persisted in the fully adjusted model with corresponding HRs of 1.71 (95% CI 1.30–2.26, P<0.001) and 1.46 (95% CI 1.13–1.88, P=0.004). MMP-2 accounted for 14.7% of association between tertile 1 PhA and CKD progression. Conclusion: Our findings revealed a previously unobserved association between BIA-derived lower PhA and CKD progression through MMP-2 in patients with T2DM. Ministry of Health (MOH) National Medical Research Council (NMRC) Published version This study was supported by the Singapore Ministry of Health’s (MOH) National Medical Research Council (NMRC) under its Clinician Scientist-Individual Research Grant (MOH-000066). The corresponding author is supported by NMRC under its Clinician Scientist Award (NMRC/CSA-INV/0020/2017). The first author is supported by NMRC under its Research Training Fellowship (NMRC/MOH000226). 2024-03-12T06:01:35Z 2024-03-12T06:01:35Z 2023 Journal Article Low, S., Pek, S. L. T., Moh, A. M. C., Khoo, J., Ang, K., Tang, W. E., Lim, Z., Subramaniam, T., Sum, C. F. & Lim, S. C. (2023). Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients. Annals of the Academy of Medicine Singapore, 52(3), 125-134. https://dx.doi.org/10.47102/annals-acadmedsg.2022350 0304-4602 https://hdl.handle.net/10356/174030 10.47102/annals-acadmedsg.2022350 2-s2.0-85176908961 3 52 125 134 en MOH-000066 NMRC/CSA-INV/0020/2017 NMRC/MOH000226 Annals of the Academy of Medicine Singapore © 2023 The Annals, Academy of Medicine, Singapore. This is an open-access article distributed under the terms of the Creative Commons License. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Medicine, Health and Life Sciences
Bio-impedance analysis
Chronic kidney disease
spellingShingle Medicine, Health and Life Sciences
Bio-impedance analysis
Chronic kidney disease
Low, Serena
Pek, Sharon Li Ting
Moh, Angelia Mei Chung
Khoo, Jonathon
Ang, Keven
Tang, Wern Ee
Lim, Ziliang
Subramaniam, Tavintharan
Sum, Chee Fang
Lim, Su Chi
Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
description Introduction: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is the angle of vector determined by the body’s resistance and reactance. It indicates cellular integrity and hydration status. Though extracellular volume excess was associated with chronic kidney disease (CKD) progression, the association between PhA and CKD progression is unknown. Matrix metalloproteinase-2 (MMP-2) is a member of zinc-dependent endopeptidase family and promotes renal interstitial fibrosis. We investigated association between PhA and CKD progression, and whether the association was through MMP-2 in patients with type 2 diabetes mellitus (T2DM). Method: We conducted a prospective study on 1,078 patients with T2DM (mean age 58.9±9.1 years). PhA was measured using BIA. CKD progression was defined as ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline with deterioration across eGFR categories. Multiplex immunoassay was used to quantitate MMP-2. We examined association between PhA and CKD progression using Cox proportional hazards model, adjusting for demographics, clinical parameters and medications. Results: Over 8.6 years of follow-up, 43.7% of participants had CKD progression. Compared to tertile 3 PhA (higher level), tertiles 1 and 2 PhA were associated with higher hazards of CKD progression, with corresponding unadjusted hazard ratios (HRs) of 2.27 (95% confidence interval [CI] 1.80–2.87, P<0.001) and 1.57 (95% CI 1.24–2.01, P<0.001). The positive association between tertiles 1 and 2 PhA with CKD progression persisted in the fully adjusted model with corresponding HRs of 1.71 (95% CI 1.30–2.26, P<0.001) and 1.46 (95% CI 1.13–1.88, P=0.004). MMP-2 accounted for 14.7% of association between tertile 1 PhA and CKD progression. Conclusion: Our findings revealed a previously unobserved association between BIA-derived lower PhA and CKD progression through MMP-2 in patients with T2DM.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Low, Serena
Pek, Sharon Li Ting
Moh, Angelia Mei Chung
Khoo, Jonathon
Ang, Keven
Tang, Wern Ee
Lim, Ziliang
Subramaniam, Tavintharan
Sum, Chee Fang
Lim, Su Chi
format Article
author Low, Serena
Pek, Sharon Li Ting
Moh, Angelia Mei Chung
Khoo, Jonathon
Ang, Keven
Tang, Wern Ee
Lim, Ziliang
Subramaniam, Tavintharan
Sum, Chee Fang
Lim, Su Chi
author_sort Low, Serena
title Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
title_short Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
title_full Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
title_fullStr Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
title_full_unstemmed Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
title_sort association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
publishDate 2024
url https://hdl.handle.net/10356/174030
_version_ 1794549453185613824