Original InvestigationAssociations of Plasma Biomarkers of Inflammation, Fibrosis, and Kidney Tubular Injury With Progression of Diabetic Kidney Disease: A Cohort Study
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Section snippets
Study Overview
REGARDS is a population-based, longitudinal cohort study designed to examine underlying causes for racial and regional differences in stroke rates in the United States. Details of the study design have been published elsewhere.14 Briefly, the study was designed to provide approximately equal representation of men and women and oversampled Black individuals as well as those living in the southeastern United States. Trained interviewers conducted computer-assisted telephone interviews to obtain
Study Population
Of the 594 participants, 47% were men and 53% were Black individuals; baseline mean age was 70 years, and mean eGFR was 44 mL/min/1.73 m2. Other baseline characteristics of the study sample are depicted overall and by quartiles of plasma KIM-1 level in Table 1. Baseline characteristics across quartiles of other biomarkers largely aligned with KIM-1 and are depicted in Tables S1-S5. In general, participants in higher quartiles of KIM-1 level were younger, were more likely to be Black, were more
Discussion
In this study of older adults with diabetes and CKD, plasma markers of inflammation/fibrosis (TNFR1, TNFR2, and YKL-40) and tubular injury (KIM-1) were associated with higher risk of KFRT independent of established risk factors, including baseline eGFR and UACR.
Prior studies have shown that higher concentrations of TNFR1 and TNFR2 are associated with greater risk of kidney function decline in individuals with diabetes and CKD.8,9,11 The results of the present study are in accordance with these
Article Information
Authors’ Full Names and Academic Degrees
Orlando M. Gutiérrez, MD, MMSc, Michael G. Shlipak, MD, MPH, Ronit Katz, DPhil, Sushrut S. Waikar, MD, MPH, Jason H. Greenberg, MD, MHS, Sarah J. Schrauben, MD, MSCE, Steven Coca, DO, MS, Chirag R. Parikh, MBBS, PhD, Ramachandran S. Vasan, MD, Harold I. Feldman, MD, MSCE, Paul L. Kimmel, MD, Mary Cushman, MD, MSc, Joseph V. Bonventre, MD, PhD, Mark J. Sarnak, MD, MS, and Joachim H. Ix, MD, MAS.
Authors’ Contributions
Research idea and study design: OMG, MGS, MJS, JHI; data acquisition: OMG, MGS, MJS, JHI; data
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2022, Kidney International ReportsCitation Excerpt :Using blood rather than urine, prior studies demonstrated that higher plasma concentrations reflecting both inflammation and tubule injury—particularly tumor necrosis factor receptor-1, tumor necrosis factor receptor-2, and plasma KIM-1—were independently associated with progression of kidney disease in diabetes.39,40 Our CKD Biomarkers Consortium collaborators have built on these prior studies, finding that plasma KIM-1, YKL-40, tumor necrosis factor receptor-1, and tumor necrosis factor receptor-2 were independently associated with incident ESKD among REGARDS participants with diabetes and CKD.41 The present study complements this work by reinforcing the importance of tubulointerstitial disease in persons with diabetes and CKD, but it has the important distinction of measuring novel biomarkers in urine rather than plasma.
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