Biomarkers of rapid chronic kidney disease progression in type 2 diabetes

Helen C. Looker (Lead / Corresponding author), Marco Colombo, Sibylle Hess, Mary J. Brosnan, Bassam Farran, R. Neil Dalton, Max C. Wong, Charles Turner, Colin N. A. Palmer, Everson Nogoceke, Leif Groop, Veikko Salomaa, David B. Dunger, Felix Agakov, Paul M. McKeigue, Helen M. Colhoun, on behalf of the SUMMIT Investigators

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    Here we evaluated the performance of a large set of serum biomarkers for the prediction of rapid progression of chronic kidney disease (CKD) in patients with type 2 diabetes. We used a case-control design nested within a prospective cohort of patients with baseline eGFR 30-60 ml/min per 1.73 m2. Within a 3.5-year period of Go-DARTS study patients, 154 had over a 40% eGFR decline and 153 controls maintained over 95% of baseline eGFR. A total of 207 serum biomarkers were measured and logistic regression was used with forward selection to choose a subset that were maximized on top of clinical variables including age, gender, hemoglobin A1c, eGFR, and albuminuria. Nested cross-validation determined the best number of biomarkers to retain and evaluate for predictive performance. Ultimately, 30 biomarkers showed significant associations with rapid progression and adjusted for clinical characteristics. A panel of 14 biomarkers increased the area under the ROC curve from 0.706 (clinical data alone) to 0.868. Biomarkers selected included fibroblast growth factor-21, the symmetric to asymmetric dimethylarginine ratio, β2-microglobulin, C16-acylcarnitine, and kidney injury molecule-1. Use of more extensive clinical data including prebaseline eGFR slope improved prediction but to a lesser extent than biomarkers (area under the ROC curve of 0.793). Thus we identified several novel associations of biomarkers with CKD progression and the utility of a small panel of biomarkers to improve prediction.Kidney International advance online publication, 22 July 2015; doi:10.1038/ki.2015.199.

    Original languageEnglish
    Pages (from-to)888-896
    Number of pages9
    JournalKidney International
    Issue number4
    Early online date22 Jul 2015
    Publication statusPublished - Oct 2015


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