Promarkerd predicts renal function decline in type 2 diabetes in the canagliflozin cardiovascular assessment study (Canvas)

Abstract

The ability of current tests to predict chronic kidney disease (CKD) complicating diabetes is limited. This study investigated the prognostic utility of a novel blood test, PromarkerD, for predicting future renal function decline in individuals with type 2 diabetes from the CANagliflozin CardioVascular Assessment Study (CANVAS). PromarkerD scores were measured at baseline in 3568 CANVAS participants (n = 1195 placebo arm, n = 2373 canagliflozin arm) and used to predict incident CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 during follow‐up in those above this threshold at baseline) and eGFR decline ≥30% during the 4 years from randomization. Biomarker concentrations (apolipoprotein A‐IV (apoA4), CD5 antigen‐like (CD5L/AIM) and insulin‐like growth factor‐binding protein 3 (IGFBP3) measured by mass spectrometry were combined with clinical data (age, serum high‐density lipoprotein (HDL)‐ cholesterol, eGFR) using a previously defined algorithm to provide PromarkerD scores categorized as low‐, moderate‐ or high‐risk. The participants (mean age 63 years, 33% females) had a median PromarkerD score of 2.9%, with 70.5% categorized as low‐risk, 13.6% as moderate‐risk and 15.9% as high‐risk for developing incident CKD. After adjusting for treatment, baseline PromarkerD moderate‐risk and high‐risk scores were increasingly prognostic for incident CKD (odds ratio 5.29 and 13.52 versus low‐risk, respectively; both p < 0.001). Analysis of the PromarkerD test system in CANVAS shows the test can predict clinically significant incident CKD in this multi‐center clinical study but had limited utility for predicting eGFR decline ≥30%.