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Biomarkers of rapid chronic kidney disease progression in type 2 diabetes.
- Source :
-
Kidney international [Kidney Int] 2015 Oct; Vol. 88 (4), pp. 888-96. Date of Electronic Publication: 2015 Jul 22. - Publication Year :
- 2015
-
Abstract
- 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 m(2). 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.
- Subjects :
- Aged
Aged, 80 and over
Area Under Curve
Biomarkers blood
Case-Control Studies
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 diagnosis
Diabetes Mellitus, Type 2 physiopathology
Diabetic Nephropathies diagnosis
Diabetic Nephropathies etiology
Diabetic Nephropathies physiopathology
Disease Progression
Female
Glomerular Filtration Rate
Humans
Kidney physiopathology
Logistic Models
Male
Odds Ratio
Predictive Value of Tests
Prospective Studies
ROC Curve
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic etiology
Renal Insufficiency, Chronic physiopathology
Reproducibility of Results
Risk Factors
Scotland
Time Factors
Diabetes Mellitus, Type 2 blood
Diabetic Nephropathies blood
Kidney metabolism
Renal Insufficiency, Chronic blood
Subjects
Details
- Language :
- English
- ISSN :
- 1523-1755
- Volume :
- 88
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Kidney international
- Publication Type :
- Academic Journal
- Accession number :
- 26200946
- Full Text :
- https://doi.org/10.1038/ki.2015.199