Urinary adiponectin strongly and independently predicted the progression of diabetic nephropathy from macroalbuminuria to end-stage renal disease in patients with type 1 diabetes, according to research published in Diabetes Care.

The findings on urinary adiponectin (uADP) provide added predictive benefit to current biomarkers including albumin excretion rates (AER) and estimated glomerular filtration rates, according to researchers.  

“From a clinical point of view, these results are important because the risk of progression to end-stage renal disease in patients with type 1 diabetes is not easy to assess based on either AER or eGFR given each measure’s limitations,” the researchers wrote.

Nicolae M. Panduru, MD, MSc, PhD,of the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, and colleagues measured uADP in 2,090 patients with type 1 diabetes followed for an average of 5.8 years and in 111 individuals without diabetes.

The researchers defined progression as a change in albuminuria, based on AER, to a higher stage or development of ESRD. Various Cox regression and competing risk models were utilized to assess the predictive value of uADP for diabetic nephropathy progression.

The investigators estimated the predictive benefit added to AER or eGFR based on area under the receiver operating characteristic curve, integrated discrimination improvement, ongoing net reclassification improvement and other statistical indexes. Multiple regression analyses were used to investigate uADP determinants.

Progression to ESRD was independently predicted by uADP (HR = 1.6; P < .001) with capability greater than AER (P= .04) and as good as eGFR (P = .79).

Further, uADP added significant predictive value when used with AER based on integrated discrimination improvement (0.115; P < .0001) and net reclassification improvement (0.794; P = .03). The same was seen when used with eGFR based on integrated discrimination improvement (0.087; P < .0001) and net reclassification improvement (0.637; P< .001).

Glycemic control, tubular injury and AER were common determinants of uADP.

“In patients with type 1 diabetes and macroalbuminuria, uADP not only is a strong independent predictor for diabetic nephropathy progression to ESRD, but also adds significant predictive benefit when used together with either AER or eGFR,” the researchers wrote. “This may be due to uADP capturing recognized risk factors for diabetic nephropathy progression such as glomerular damage, tubular dysfunction, and glycemic control as well as other factors important for diabetic nephropathy progression like cachexia.” – by Allegra Tiver

Disclosure: Analyses and assays were partly sponsored by Roche Diagnostics. Please see study for full list of researchers’ relevant financial disclosures.

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