Treatment

New diagnostic tool can help predict risk of diabetic kidney complications

by Barbara Hewitt on April 20, 2017

Kidney complications are a risk for people with type 1 and type 2 diabetes but now scientists in the United States have develop a tool that can accurately predict some risk.

The researchers from the Joslin Diabetes Centre say the test can predict the risk of end stage renal disease (ESRD) and could help with the development of more effective therapies to prevent or treat kidney failure.

In the past, doctors have relied mostly on two biomarkers, urinary albumin to creatinine ratio (ACR) and estimated glomerular filtration rate, to identify those at higher risk of kidney failure.

But researchers say that those criteria miss a large proportion of patients who are at high risk of the disease and fail to predict accurately time of onset of ESRD.

In 2012 Dr. Andrzej Krolewski head of genetics and epidemiology at the centre, and his team made a very important discovery when they found a link between tumour necrosis factor receptor 1 (TNFR1) and declining renal function in people type 1 and type 2 diabetes.

Building on this breakthrough research, the researchers sought to translate that discovery into a practical prognostic test that doctors could use to assess care and enrol patients in clinical trials.

For this study, the researchers used data from a population of patients with both diabetes and chronic kidney disease enrolled in follow up studies and found that specific values of two biomarkers, circulating level of TNFR1 and ACR combined, indicated a high risk of ESRD.

The team then validated these findings in a cohort of patients with type 2 diabetes and found that the prognostic test for type 2 diabetes was similar to type 1. Overall the composite prognostic criterion had a sensitivity value (detecting those at risk) of 7% and positive prognostic value of 81%.

‘Remarkably, when we used the TNF receptor to analyse risk of ESRD, the risk was almost identical for both type 1 and type 2 diabetes. This implies that the etiologies are similar and this is a very important observation because in the medical community, the impression is that the progression to ESRD in type 1 is somehow different from type 2. As a result, many clinical trials do not include patients with type 1 diabetes,’ said Krolewski.

According to Marlon Pragnell, JDRF senior scientific programme manager, the prognostic tool will dramatically reduce the cost of clinical trials and help expand the pipeline of therapies for people with diabetic nephropathy.

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