USE OF BIOMARKERS REPRESENTING CARDIAC, VASCULAR AND INFLAMMATORY PATHWAYS FOR THE PREDICTION OF ACUTE KIDNEY INJURY IN PATIENTS WITH TYPE 2 DIABETES

摘要

Acute kidney injury (AKI) is a related to chronic kidney disease and death in patients from the general population, with or without type 2 diabetes. Nevertheless AKI biomarkers are rarely validated in diabetes population. The inventors aimed to explore the individual and combined prognostic value of 7 circulating candidate markers for AKI. This include markers of cardiac and endothelial dysfunction (mid-regional-pro-adrenomedullin [MRproADM], angiopoietinlike-2 [ANGPTL2], N-terminal prohormone brain natriuretic peptide [NTproBNP]) oxidative stress (fluorescent advanced glycation endproducts [AGE], carbonyls), cardio-renal pathways (copeptin [CTproAVP]), and inflammation (soluble TNF receptor 1 [TNFR1]). They prospectively followed-up 1345 (565 women/780 men) type 2 diabetes participants of a French single-centre hospital-based cohort (SURDIAGENE). In univariate analysis, each biomarker was significantly associated with AKI, and 6 remained associated after multivariable adjustment. The addition of a multimarker score summing standardized and weighted values of these 6 markers to the model including usual risk factors significantly improved C-statistics (0.724 to 0.759, P0.0001), and 5-year risk-predictive performance (relative integrated discrimination improvement index=0.435, P0.0001). Thus the panel of 6 biomarkers representing cardiac, vascular and inflammatory pathways improves the prediction of AKI over usual risk factors in patients with type 2 diabetes.