1. Urinary metabolite profiling and risk of progression of diabetic nephropathy in 2670 individuals with type 1 diabetes
- Author
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Erkka Valo, Kristian Nybo, Carol Forsblom, Lassi Raivonen, Niina Sandholm, Lena M. Thorn, Peter Würtz, Viljami Aittomäki, Stefan Mutter, Per-Henrik Groop, Clinicum, Nefrologian yksikkö, HUS Abdominal Center, CAMM - Research Program for Clinical and Molecular Metabolism, Research Programs Unit, Department of General Practice and Primary Health Care, Medicum, Department of Medicine, and Per Henrik Groop / Principal Investigator
- Subjects
BLOOD ,Endocrinology, Diabetes and Metabolism ,Metabolite ,DIVERSITY ,Urine ,Diabetic nephropathy ,Gastroenterology ,DISEASE ,chemistry.chemical_compound ,0302 clinical medicine ,AMINO-ACIDS ,Diabetic Nephropathies ,Prospective Studies ,INSULIN-RESISTANCE ,0303 health sciences ,Progression ,SIGNATURE ,ASSOCIATION ,3. Good health ,Type 1 diabetes ,Creatinine ,Disease Progression ,Population study ,medicine.symptom ,medicine.medical_specialty ,Urinary system ,030209 endocrinology & metabolism ,GFR ,Article ,03 medical and health sciences ,KIDNEY ,Metabolite profiling ,Internal medicine ,Internal Medicine ,medicine ,Albuminuria ,Humans ,030304 developmental biology ,business.industry ,medicine.disease ,TRANSPORT ,NMR ,Diabetes Mellitus, Type 1 ,chemistry ,3121 General medicine, internal medicine and other clinical medicine ,business ,Kidney disease - Abstract
Aims/hypothesis This prospective, observational study examines associations between 51 urinary metabolites and risk of progression of diabetic nephropathy in individuals with type 1 diabetes by employing an automated NMR metabolomics technique suitable for large-scale urine sample collections. Methods We collected 24-h urine samples for 2670 individuals with type 1 diabetes from the Finnish Diabetic Nephropathy study and measured metabolite concentrations by NMR. Individuals were followed up for 9.0 ± 5.0 years until their first sign of progression of diabetic nephropathy, end-stage kidney disease or study end. Cox regressions were performed on the entire study population (overall progression), on 1999 individuals with normoalbuminuria and 347 individuals with macroalbuminuria at baseline. Results Seven urinary metabolites were associated with overall progression after adjustment for baseline albuminuria and chronic kidney disease stage (p −4): leucine (HR 1.47 [95% CI 1.30, 1.66] per 1-SD creatinine-scaled metabolite concentration), valine (1.38 [1.22, 1.56]), isoleucine (1.33 [1.18, 1.50]), pseudouridine (1.25 [1.11, 1.42]), threonine (1.27 [1.11, 1.46]) and citrate (0.84 [0.75, 0.93]). 2-Hydroxyisobutyrate was associated with overall progression (1.30 [1.16, 1.45]) and also progression from normoalbuminuria (1.56 [1.25, 1.95]). Six amino acids and pyroglutamate were associated with progression from macroalbuminuria. Conclusions/interpretation Branched-chain amino acids and other urinary metabolites were associated with the progression of diabetic nephropathy on top of baseline albuminuria and chronic kidney disease. We found differences in associations for overall progression and progression from normo- and macroalbuminuria. These novel discoveries illustrate the utility of analysing urinary metabolites in entire population cohorts. Graphical abstract
- Published
- 2021