#3447 ENVIRONMENTAL MELAMINE EXPOSURE AND ADVERSE KIDNEY OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Abstract Background and Aims The impact of environmental melamine exposure on kidney outcomes in type 2 diabetes (T2D) remains unclear. The aim of this study is to evaluate the relationship between melamine and adverse kidney progression in T2D population. Method This longitudinal study enrolled 561 T2D patients during October 2016 and June 2020 and followed until December 2021. Baseline urinary melamine levels were measured by LC-MS/MS, and average daily intake (ADI) of melamine was estimated. Primary kidney outcomes were defined as doubling of serum creatinine levels or end stage kidney disease (ESKD), and secondary kidney outcomes included rapid decline in kidney function as estimated glomerular filtration rate (eGFR) decline > 5 ml/min/1.73m2/year. Results Baseline median urinary corrected melamine levels and estimated DI of melamine were 0.8 μg/mmol and 0.3 µg/kg/day in 561 T2D patients. During 3.7 years of follow-up, urinary corrected melamine level was positively correlated with reaching composite outcomes of either doubling of serum creation levels or ESKD and rapid decline in kidney function. Those with the highest quartile of urinary corrected melamine had 2.96-fold risk of composite outcomes of either doubling of serum creation levels or ESKD and 2.47-fold risk of eGFR decline > 5 ml/min/1.73m2/year. Estimated ADI of melamine also had significant correlation with adverse kidney outcomes. Furthermore, the positive relationship between melamine exposure and rapid decline in kidney function was only found in T2D patients with male, baseline eGFR ≥ 60 ml/min/1.73m2 or glycated hemoglobin ≤ 7%. Conclusion Melamine exposure is significantly associated with kidney outcomes in T2D patients, especially in those with male, well sugar control or preserved baseline kidney function.