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Abstract: TH-PO173

Plasma Biomarkers and Mortality Among REGARDS Participants with Diabetes and CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical


  • Chen, Teresa K., University of California San Francisco, San Francisco, California, United States
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • Grams, Morgan, New York University, New York, New York, United States
  • Cushman, Mary, University of Vermont, Burlington, Vermont, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
  • Shlipak, Michael, University of California San Francisco, San Francisco, California, United States

Group or Team Name

  • CKD Biomarkers Consortium.

Individuals with diabetes and chronic kidney disease (CKD) are at increased risk of death but their clinical course varies. We aimed to determine whether six plasma biomarkers of kidney injury, inflammation, and repair further captured mortality risk.


Among a cohort of REGARDS participants with diabetes and creatinine-based eGFR (eGFRcr) <60 ml/min/1.73 m2 (n=594), we used Cox proportional hazards regression to evaluate associations of plasma KIM-1, TNFR1, TNFR2, MCP-1, suPAR, and YKL-40 concentrations with all-cause mortality. Covariates included sociodemographic and clinical factors, UACR, and eGFRcr or cystatin C-based eGFR (eGFRcys).


At baseline, mean age was 70 years, 47% were men, 53% were Black, mean eGFRcr and eGFRcys were 44 and 38 ml/min/1.73 m2, and median UACR was 32 mg/g. TNFR1, TNFR2, and suPAR strongly correlated with cystatin C (r=0.73-0.79). Over a mean follow-up of 6.2 years, 332 participants died. Higher baseline levels of KIM-1, TNFR1, TNFR2, and suPAR were associated with higher mortality risk in fully adjusted models that included eGFRcr (Figure 1). When accounting for eGFRcys rather than eGFRcr, however, only the association of suPAR with mortality persisted.


Among adults with diabetes and CKD, higher plasma KIM-1, TNFR1, TNFR2, and suPAR are associated with mortality, independent of baseline eGFRcr and albuminuria. However, the attenuation by eGFRcys suggests that the associations of KIM-1, TNFR1, and TNFR2 with mortality may, in part, reflect residual confounding by GFR.


  • NIDDK Support