Fasting urine osmolality and risk of kidney disease progression in patients with type 2 diabetes
Bibliographic record
Abstract
BACKGROUND AND HYPOTHESIS: Urinary concentrating capacity largely depends on the structural and functional integrity of distal tubule and peritubular compartment whilst fasting urine osmolality represents the closest estimation of the maximal urinary concentrating ability. We hypothesize that a low fasting urine osmolality is associated with high risk for kidney disease progression beyond estimated glomerular filtration rate (eGFR) reduction and albuminuria in patients with type 2 diabetes. METHODS: In this prospective study, fasting urine osmolality was measured in 1711 participants from the SMART2D (Singapore Study of Macro-angiopathy and Micro-Vascular Reactivity in Type 2 Diabetes) cohort in Singapore and 1097 participants from SURDIAGENE (SURvie, DIAbete de type 2 et GENEtique) cohort in France. The primary outcome was a composite of end-stage kidney disease or doubling of serum creatinine concentration. The secondary outcome was rapid kidney function decline (RKFD) defined as eGFR decline ≥5 mL/min/1.73 m2 per year. RESULTS: A total of 239 and 82 kidney events were identified during a mean (standard deviation) of 6.6 (1.6) and 7.4 (3.7) years of follow-up in the SMART2D and SURDIAGENE cohorts, respectively. Compared with the upper tertile, participants with fasting urine osmolality in the lowest tertile had an increased risk of the composite kidney events after adjustment for known clinical risk factors [adjusted harzard ratio 2.94 (1.12-7.69) and 1.74 (0.85-3.58)]. They also had higher odds of experiencing RKFD [adjusted odds ratio 1.47 (0.95-2.28) and 1.84 (1.06-3.19), respectively]. Exploratory analysis revealed that low fasting urine osmolality was associated with high risk of the primary kidney outcome independent of plasma copeptin concentration or urinary kidney injury molecule-1, an established biomarker of proximal tubule injury. CONCLUSIONS: A low level of fasting urine osmolality is associated with increased risk of kidney disease progression independent of conventional risk factors. This readily accessible biomarker may potentially improve risk stratification for patients with type 2 diabetes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".