Potential predictive biomarkers for early detection of diabetic kidney disease

Abstract

Background: Evidence from published studies raised doubt on microalbuminuria as a predictive marker for the development and progression of kidney disease in type 2 diabetes mellitus (T2DM) subjects. So, in this study, we are exploring the predictive potential of growth differentiation factor-15 (GDF-15) and galectin-3 biomarkers for the early detection of diabetic kidney disease (DKD). Methods and materials: This was an observational study conducted over a period of 1.2 years. The study protocol was approved by the Jamia Hamdard Institutional Ethics Committee. Patients were classified on the basis of estimated glomerular filtration rate (eGFR) and albuminuria. The receiver operating characteristic (ROC) curve was plotted to assess the diagnostic potential of the marker, sensitivity and specificity were also calculated. All the analysis was performed using SAS v9.4. Results: A total of 90 patients completed the study. Patients were grouped as normoalbuminuria (30 patients), microalbuminuria (30 patients), and macroalbuminuria (30 patients). Mean age of the patients was 58.0 ± 11.08 years. Galectin-3 and PGDF-15 levels were significantly elevated in T2DM patients with macroalbuminuria as compared to T2DM patients with microalbuminuria and normoalbuminuria (p = <0.05). The patients with poor kidney function (Stage IV-V CKD) have higher levels of galectin-3 and GDF-15. Correlation analysis showed galectin-3 levels and GDF-15 levels were positively correlated with age, serum creatinine, and UACR. While, negative correlation was observed between galectin-3 (r = −0.472), GDF-15 (r = −0.917) biomarkers and eGFR (p = 0.000). The ROC analysis of galectin-3 and GDF-15 yielded an AUC of 0.776 (95% CI: 0.677 to 0.875; p = <0.0001) and 0.963 (95% CI: 0.929 to 0.997; p = <0.0001). The sensitivity and specificity of galectin-3 in the diagnosis of DKD were 0.53 and 0.97, while for GDF-15 it was 0.93 and 0.87. Conclusion: In DKD patient's galectin-3 and GDF-15 level increases as the eGFR decreases. ROC curve also confirms the diagnosis and prediction potential of galectin-3 and PGDF-15 in DKD.