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Abstract: FR-PO456

Urinary Biomarkers of Tubular Injury Predict Renal Progression and ESRD in Type 2 Diabetes Mellitus: A Prospective Cohort Study

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Pooluea, Pimanong, Phramongkutklao Hospital, Bangkok, Thailand
  • Tasanavipas, Pamila, Phramongkutklao Hospital, Bangkok, Thailand
  • Chaiprasert, Amnart, Phramongkutklao Hospital, Bangkok, Thailand
  • Tangwonglert, Theerasak, Phramongkutklao hospital, Bangkok, Thailand
  • Nata, Naowanit, Phramongkutklao hospital, Bangkok, Thailand
  • Supasyndh, Ouppatham, Phramongkutklao Hospital, Bangkok, Thailand
  • Satirapoj, Bancha, Phramongkutklao hospital, Bangkok, Thailand

Diabetic kidney disease (DKD) typically evolves over many years. The diagnosis, evaluation and treatment are based mainly on biomarkers that assess kidney function. New potential tubular biomarkers in DKD could improve risk stratification and prediction.


A prospective cohort study, a total of 257 type 2 diabetic patients were included. The baseline values of urine albumin creatinine ratio (UACR), urine Cystatin-C to creatinine ratio (UCYS), urine angiotensinogen to creatinine ratio (UANG), urine NGAL to creatinine ratio (UNGAL) and urine KIM-1 to creatinine ratio (UKIM) were measured. The composite outcome was a rapid glomerular filtration rate (GFR) decline or incident of ESRD at 3 year follow-up.


The median follow-up period was 40.8 monthsand the composite outcome were noted in 26.1%. Urine tubular biomarkers of UCYS, UANG, UNGAL and UKIM were significantly higher among patients with rapid GFR decline or new onset of ESRD. Using univariate followed by multivariate COX proportional hazard regression analysis, the number of patients reached the composite renal endpoint was higher among those in the highest quartiles of UCYS (HR 3.86, 95% CI, 1.95-7.66), UANG (HR 3.93, 95% CI, 1.95- 7.88) UKIM (HR 3.41, 95% CI, 1.66-7.01) and UNGAL (HR 3.25, 95% CI, 1.58-6.71) than in those in the lowest quartiles. In addition, the highest quartile of UCYS, UANG, UKIM and UNGAL were associated with a 2.53 to 2.96-fold increased risk of rapid GFR decline or ESRD compared with the lowest quartile in adjusted models. All biomarkers predicted composite outcome with ROC for UACR = 0.731; 95% CI 0.65-0.81, UCYS = 0.64; 95% CI 0.56-0.72, UANG = 0.635; 95% CI 0.55-0.72, UKIM = 0.611; 95% CI 0.53-0.69 and UNGAL = 0.598; 95% CI 0.52-0.68. Highest ROC for integrated with UACR, UANG and UNGAL = 0.751; 95% CI 0.68-0.82.


The study supported that type 2 diabetic patients with high levels of urine tubular biomarkers (Cystatin-C, angiotensinogen, KIM-1 and NGAL) had more incidence of ESRD and rapid GFR decline. These tubular biomarkers may be independent predictors of the renal progression in DKD.


  • Government Support - Non-U.S.