Biomarkers and kidney function in diabetes
Biomarkers of diverse pathophysiologic mechanisms could be used to improve the risk stratification for incident or progressive diabetic kidney disease (DKD) in persons with type 2 diabetes, say researchers at the Yale University School of Medicine in Connecticut and the Icahn School of Medicine in New York. The authors performed two studies: i) a nested case-control study including 190 cases of incident DKD and 190 matched controls and ii) a prospective cohort study including 1,156 cases. In both studies, the authors used banked baseline plasma samples from participants with early (ACCORD) or advanced (VA NEPHRON-D) DKD, and found that the TNF receptors -1 and -2 (TNFR-1, -2) and the kidney injury molecule KIM-1 were independently associated with higher risk of eGFR decline in persons with early or advanced DKD. The authors suggest adding these biomarkers to clinical prognostic models, as this approach could significantly improve discrimination for the renal outcome.
At baseline, median concentrations of TNFR-1, TNFR-2, and KIM-1 were roughly twice as high in the advanced DKD population (NEPHRON-D) compared to the early DKD population (ACCORD).
In both cohorts, patients who reached the renal outcome had higher baseline levels than those who did not reach the outcome.
Both cohorts showed significant associations between doubling in TNFR-1, TNFR-2, and KIM-1 levels and risk of the renal outcomes.
Incorporating these biomarkers in clinical models increased the area under the curve (SEM) for predicting the renal outcome from 0.68 (0.02) to 0.75 (0.02) in NEPHRON-D.
TNFR-1, TNFR-2, and KIM-1 are independently associated with higher risk of eGFR decline in persons with early or advanced DKD.