Distinct Biomarkers for Early Diagnosis of Diabetic Nephropathy

Abstract

Optimization of biomarkers for a clinical situation requires a prospective validation in large numbers of patients with diabetic nephropathy and needs to be performed in different critically ill populations.

Prediction of Nephropathy in Type 2 Diabetes: An Analysis of the ACCORD Trial Applying Machine Learning Techniques

“…The large number of patients with T2DM who developed DN within the first year may be explained by the design of the ACCORD study, which was intended to investigate whether intensive vs. standard therapies that normalize a patient's HbA1c would have an impact on the incidence of cardiovascular events . Presence of DN in the first 6 months may only represent transient changes in kidney perfusion or function . Yet, given the fact that none of these patients developed micro‐albuminuria by that time, they are likely predominantly in stage 2 of DN, where hyperfiltration is observed .…”

“…The ACCORD data set did not include more novel biomarkers of DN; it only contains routinely measured clinical factors, such as eGFR, SCr, HbA1c, etc. Testing of other predictive biomarkers, such as tumor necrosis factor‐α, transforming growth factor‐β, vascular endothelial growth factor, or interleukin‐1β, that may be more closely related to mechanisms of DN pathogenesis was not possible. However, studies focusing on the pathophysiologic mechanism of diabetic kidney disease have been performed showing that tumor necrosis factor receptor‐1, tumor necrosis factor receptor‐2, and plasma kidney injury molecule‐1 are associated with higher risk of eGFR decline in persons with T2DM with early and advanced diabetic kidney disease …”

“…One of the most common complications of type 2 diabetes attributed to microvascular changes is diabetic nephropathy (DN), which is the main cause of end‐stage renal disease (ESRD) and death among patients with T2DM . Clinically, DN is characterized by hypertension, proteinuria, and a progressive decline in glomerular filtration rate (GFR) leading to ESRD . Based on the magnitude of urinary albumin excretion rate, DN has been categorized into five stages.…”

“…Based on the magnitude of urinary albumin excretion rate, DN has been categorized into five stages. The initial stage is characterized by renal hyperfiltration and hypertrophy, the second stage is a long silent period without overt clinical signs and symptoms of nephropathy, microalbuminuria appears during the third stage worsening to macro‐albuminuria in the fourth stage, the fifth stage is a progressively severe decline in renal function that leads to ESRD . Standard treatments include glycemic and hypertension control following the “Standards of Medical Care for Patients with Diabetes Mellitus” developed by the American Diabetes Association…”

“…[3][4][5][6] Clinically, DN is characterized by hypertension, proteinuria, and a progressive decline in glomerular filtration rate (GFR) leading to ESRD. 3,7,8 Based on the magnitude of urinary albumin…”