Association of plasma soluble CD146 level with atherosclerosis and its prognosis in patients with diabetic kidney disease.

Objective To investigate the relationship of soluble CD₁₄₆ (sCD₁₄₆) with atherosclerosis and future cardiovascular events in patients with diabetic kidney disease (DKD). Methods A total of 105 DKD patients at chronic kidney disease(CKD) (68 male, 37 female) stage 1-3 were enrolled and another 94 type 2 diabetes mellitus patients without DKD (64 male, 30 female) entered the control group from January 2013 to December 2015 in our hospital. Plasma concentration of sCD₁₄₆ was measured. Doppler ultrasounds of carotid and lower extremity artery were performed. All the DKD patients were retrospectively followed up (medium follow-up 28 months) .The differences of sCD₁₄₆ between DKD patients and control group was analyzed and the relationship between sCD₁₄₆ and proteinuria and renal function was evaluated in DKD patients. The association between sCD₁₄₆ and atherosclerosis was explored in DKD patients. Kaplan-Meier method was used to evaluate the predictive value of sCD₁₄₆ in future cardiovascular events. Results The level of sCD₁₄₆ in diabetes mellitus patients was lower than that of DKD group [the level of sCD₁₄₆ was (435± 150) and (602 ± 274) µg/L, respectively, t=-5.246, P<0.001]. Spearman analysis showed the positive association between sCD₁₄₆ and serum creatinine (r=0.36, P<0.001), urinary albumino-to-creatinine ratio (r= 0.225, P=0.001) and its negative correlation with eGFR (r=-0.376, P<0.001). The elevation of sCD₁₄₆ was further associated with the progression of CKD [the levels of sCD₁₄₆ in patients of CKD stage 1, 2 and 3 were (472 ± 172), (590 ± 223), (685 ± 340) µg/L, respectively, F=164.203, P<0.001]. In DKD group, the upregulation of sCD₁₄₆ was associated with both the increase of carotid intima-media thickness (r=0.577, P< 0.001) and femoral intima-media thickness (r=0.765, P<0.001). Patients with higher level of sCD₁₄₆ tended to have more carotid plaques [OR(95%CI)=17.302(2.752-108.780), P=0.002], unstable carotid plaques [OR (95%CI)=6.404(1.036-39.608), P=0.046] and unstable plaques in lower extremity arteries [OR(95%CI)= 13.641(1.942- 95.825), P=0.009] after the adjustment of other cardiovascular risks. Patients with higher concentration of sCD₁₄₆ tended to have poorer cardiovascular outcomes (Log rank χ²=9.366, P=0.049). Conclusions The measurement of plasma sCD₁₄₆ is a noninvasive way which can sensitively reflect the progression of renal function and atherosclerosis, and it can also be a good marker to predict cardiovascular outcomes in DKD patients at CKD stage 1-3. [ABSTRACT FROM AUTHOR]