(1.15) Soluble tumor necrosis factor receptor type 1 is an alternative marker of urinary albumin-creatinine ratio and estimated glomerular filtration rate for predicting the progression of renal function in patients with type 2 diabetes mellitus

Thursday, May 9, 2024

10:25 AM – 10:40 AM CDT

Location: ePoster Showcase, Empire Ballroom Foyer, Level 2

Submitter(s)

LIANG-YU LIN, MD, PhD

Attending Physician, Associate Professor
Taipei Veterans General Hospital
TAIPEI CITY, Taiwan (Republic of China)

Objective : Urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rates (eGFR) predict risks of worsening diabetic kidney disease (DKD) but have limitations. Soluble tumor necrosis factor receptor type 1 (sTNFR1) was a biomarker of DKD but comparisons of predictability of sTNFR1 and UACR plus eGFR levels were unknown.

Methods: A prospective cohort of subjects with T2D for investigating risk factors of worsening DKD was conducted. Renal events were defined as > 30% loss of eGFR confirmed by consecutive tests after 6 months. The associations of sTNFR1, UACR, and eGFR levels and risks of renal events were tested in COX regression model and area under curve (AUC) of sTNFR1 levels and variables of UACR plus eGFR were compared in receiver operating characteristic (ROC) analysis. The accuracy of stratification was checked by Kaplan–Meier analysis.

Results: Levels of sTNFR1 and UACR were associated with risks of declines of eGFR > 30% after adjusting relevant factors. The associations of sTNFR1 levels and renal outcomes were independent of status of UACR and eGFR at baseline. The AUC of ROC curve of sTNFR1 level was comparable with the combination of UACR plus eGFR (0.73 versus 0.71, p=0.72) and results remain for quartile groups of sTNFR1 and risk categories of Kidney Disease: Improving Global Outcomes (KDIGO) (0.70 versus 0.71, p=0.84). Both stratifications by sTNFR1 levels and KDIGO were accurate.

Discussion/Conclusion:

Discussion: We demonstrated that the associations of sTNFR1 levels and declines of renal function in subjects with type 2 diabetes and the predictabilities of sTNFR1 levels were similar to the combinations of levels of UACR and eGFR as well as the risk categories of KDIGO. Even the risk categories of KDIGO were wildly used, the limitations of the method should be notified. First, the accurate estimations of renal risks might be hindered by the unsatisfied completeness of urinary exam in clinical setting but the rate of blood sampling was relative better. Second, the sTNFR1 levels were directly measured in commercial kits but eGFR levels were indirectly determined by equations which the weights of rescales might be affected by ethnicity, age, or sex. Furthermore, for diabetic subjects free from albuminuria and apparent renal function decline, risk categories of KDIGO were not applicable for identifying subjects at renal risks.

Conclusion: Levels of sTNFR1 could be an alternative marker for identifying diabetic subjects with risks of declining renal function in clinical practice.