Limits...
Urine haptoglobin levels predict early renal functional decline in patients with type 2 diabetes.

Bhensdadia NM, Hunt KJ, Lopes-Virella MF, Michael Tucker J, Mataria MR, Alge JL, Neely BA, Janech MG, Arthur JM, Veterans Affairs Diabetes Trial (VADT) study gro - Kidney Int. (2013)

Bottom Line: Diabetic nephropathy is the leading cause of end-stage renal disease.We then measured this in the urine of 204 patients with type 2 diabetes who did not yet have significant kidney disease (estimated glomerular filtration rate stage 2 or better and an albumin to creatinine ratio <300 mg/g).Addition of the haptoglobin to creatinine ratio to a model using the albumin to creatinine ratio to predict early renal function decline resulted in improved predictive performance.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

ABSTRACT
Diabetic nephropathy is the leading cause of end-stage renal disease. The urinary albumin to creatinine ratio is used as a predictor for the development of nephropathy but it is neither sensitive nor specific. Here we used liquid chromatography/mass spectrometry on urine of eight normoalbuminuric patients with type 2 diabetes from the VA Diabetes Trial to identify candidate markers for loss of renal function. Initial verification of seven markers (agrin, haptoglobin, mannan-binding lectin serine protease 2, LAMP-2, angiotensinogen, NGAL, and uromodulin) in the urine of an additional 30 patients showed that haptoglobin was the best predictor of early renal functional decline. We then measured this in the urine of 204 patients with type 2 diabetes who did not yet have significant kidney disease (estimated glomerular filtration rate stage 2 or better and an albumin to creatinine ratio <300 mg/g). In comparing the highest to lowest tertiles, the odds ratio for having early renal function decline was 2.70 (CI: 1.15, 6.32) using the haptoglobin to creatinine ratio compared with 2.50 (CI 1.14, 5.48) using the albumin to creatinine ratio after adjusting for treatment group and use of ACE inhibitors. Addition of the haptoglobin to creatinine ratio to a model using the albumin to creatinine ratio to predict early renal function decline resulted in improved predictive performance. Thus, the haptoglobin to creatinine ratio may be useful to predict patients with type 2 diabetes at risk of nephropathy before the development of macroalbuminuria or reduced glomerular filtration rate.

Show MeSH

Related in: MedlinePlus

© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672380&req=5

Mentions: Spearman rank correlation between ACR and HCR was relatively weak (0.25) and the ROC AUC values for combinations of ACR and HCR were (non-significantly) higher (table 4). We used net reclassification to determine if HCR improved the prediction by ACR. The integrated discrimination improvement (IDI) comparing the two models was statistically significant and estimated to be 0.02 (p-value=0.045) using the probability cut-point associated with an ACR level of 30 mg/g (table 5). The improvement in IDI demonstrates the added prognostic value that HCR provides to standard estimation using ACR. Of the 51 subjects who developed ERFD, classification improved for 7 patients using the model with HCR, but became worse for 2 patients. This resulted in a non-significant net gain in reclassification proportion for subjects who experienced an event of 0.098 (p-value=0.095). Of the 153 subjects who did not develop ERFD, classification improved for 9 patients, but became worse for 9 other patients. The NRI was estimated to be 0.098 (p-value=0.131). Net reclassification resulted in a nonsignificant improvement in sensitivity from 37.3% to 47.1% while specificity was unchanged at 78.4% (Figure 4).


Urine haptoglobin levels predict early renal functional decline in patients with type 2 diabetes.

Bhensdadia NM, Hunt KJ, Lopes-Virella MF, Michael Tucker J, Mataria MR, Alge JL, Neely BA, Janech MG, Arthur JM, Veterans Affairs Diabetes Trial (VADT) study gro - Kidney Int. (2013)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672380&req=5

Mentions: Spearman rank correlation between ACR and HCR was relatively weak (0.25) and the ROC AUC values for combinations of ACR and HCR were (non-significantly) higher (table 4). We used net reclassification to determine if HCR improved the prediction by ACR. The integrated discrimination improvement (IDI) comparing the two models was statistically significant and estimated to be 0.02 (p-value=0.045) using the probability cut-point associated with an ACR level of 30 mg/g (table 5). The improvement in IDI demonstrates the added prognostic value that HCR provides to standard estimation using ACR. Of the 51 subjects who developed ERFD, classification improved for 7 patients using the model with HCR, but became worse for 2 patients. This resulted in a non-significant net gain in reclassification proportion for subjects who experienced an event of 0.098 (p-value=0.095). Of the 153 subjects who did not develop ERFD, classification improved for 9 patients, but became worse for 9 other patients. The NRI was estimated to be 0.098 (p-value=0.131). Net reclassification resulted in a nonsignificant improvement in sensitivity from 37.3% to 47.1% while specificity was unchanged at 78.4% (Figure 4).

Bottom Line: Diabetic nephropathy is the leading cause of end-stage renal disease.We then measured this in the urine of 204 patients with type 2 diabetes who did not yet have significant kidney disease (estimated glomerular filtration rate stage 2 or better and an albumin to creatinine ratio <300 mg/g).Addition of the haptoglobin to creatinine ratio to a model using the albumin to creatinine ratio to predict early renal function decline resulted in improved predictive performance.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

ABSTRACT
Diabetic nephropathy is the leading cause of end-stage renal disease. The urinary albumin to creatinine ratio is used as a predictor for the development of nephropathy but it is neither sensitive nor specific. Here we used liquid chromatography/mass spectrometry on urine of eight normoalbuminuric patients with type 2 diabetes from the VA Diabetes Trial to identify candidate markers for loss of renal function. Initial verification of seven markers (agrin, haptoglobin, mannan-binding lectin serine protease 2, LAMP-2, angiotensinogen, NGAL, and uromodulin) in the urine of an additional 30 patients showed that haptoglobin was the best predictor of early renal functional decline. We then measured this in the urine of 204 patients with type 2 diabetes who did not yet have significant kidney disease (estimated glomerular filtration rate stage 2 or better and an albumin to creatinine ratio <300 mg/g). In comparing the highest to lowest tertiles, the odds ratio for having early renal function decline was 2.70 (CI: 1.15, 6.32) using the haptoglobin to creatinine ratio compared with 2.50 (CI 1.14, 5.48) using the albumin to creatinine ratio after adjusting for treatment group and use of ACE inhibitors. Addition of the haptoglobin to creatinine ratio to a model using the albumin to creatinine ratio to predict early renal function decline resulted in improved predictive performance. Thus, the haptoglobin to creatinine ratio may be useful to predict patients with type 2 diabetes at risk of nephropathy before the development of macroalbuminuria or reduced glomerular filtration rate.

Show MeSH
Related in: MedlinePlus