Abstract
Diabetes is a leading cause of chronic kidney disease. African Americans are disproportionately burdened by diabetic kidney disease (DKD) and end stage renal disease (ESRD). Disparities in DKD have genetic and socioeconomic components, yet its prevalence in African Americans is not adequately studied. The current study evaluated undiagnosed DKD in uninsured and underinsured African American men in Greensboro, North Carolina. Participants consisted of three groups: non‐diabetic controls, diabetic patients without known kidney disease, and diabetic patients with diagnosed DKD. Our data reveal undiagnosed kidney injury in a significant proportion of the diabetic patients, based on urinary albumin to creatinine ratio (ACR) which is the gold standard clinical test for DKD. The sensitivity of multiple other kidney injury biomarkers, namely kidney injury molecule‐1 (KIM‐1), cystatin C, and neutrophil gelatinase‐associated lipocalin (NGAL), were also tested in the current study through comparison to ACR. Compared with the normoalbuminuria group (ACR<30 mg/g), only the macroalbuminuria (ACR>300 mg/g) and not the microalbuminuria (300 mg/g>ACR>30 mg/g) group showed increased plasma levels for cystatin C, and increased urinary levels for KIM‐1, cystatin C and NGAL. Also, for plasma, plasma KIM‐1 showed higher levels in the microalbuminuria group than the normoalbuminuria group. In summary, plasma KIM‐1 showed the highest sensitivity in response to increased ACR in the African American subpopulation in our study. We also found the urinary levels of two metalloproteases, meprin A and meprin B, and two of their targets, nidogen‐1 and monocytes chemoattractant protein‐1, increased with severity of kidney injury, which suggests a role for meprin metalloproteases in the pathophysiology of DKD in this subpopulation. Our study has overall revealed undiagnosed kidney injury in a significant proportion of uninsured and underinsured diabetic African American men in the City of Greensboro, North Carolina, and demonstrates a need for more aggressive tests to assess kidney injury in uninsured diabetic patients to facilitate early diagnosis and targeted interventions that could slow progression to ESRD.Support or Funding InformationThis study was supported by the Minority Men's Health Initiative (MMHI) through NIH/NIMHD Center Award # U54MD008621 (CFDA 93.307), Sub‐Awards # HU140400 (to RHN and EMO) and HU150006 (to EMO and SHH); and the NIH/NIGMS Award Number SC3GM102049 to EMO.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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