Gdf-15 a potential biomarker of diabetic nephropathy in iraq patients with chronic kidney disease

Abstract

Growth differentiation factor-15 (GDF-15) expression increase exposure to tissue injury and has recently emerged as a useful biomarker for multiple diseases. This study is aimed at detecting serum GDF-15 in patients with chronic kidney disease (CKD) and assessing its value in the early diagnosis of diabetic nephropathy (DN). This cross-sectional study, involved a total of 60 patients with CKD aged 15-65 years, selected according to their albumin creatinine ratio (ACR): >30 mg/g (DN 42), and ACR <30 mg/g (without DN 18), patients were compared with 28 healthy participants. Serum GDF-15 level, hematological, and biochemical parameters were measured. In the DN group, levels of GDF-15, C-reactive protein (CRP), urea, and creatinine were significantly higher, while RBCs, Hb, and GFR were significantly lower (p < 0.05) in comparison with CKD non-DN group. GDF-15 was significantly negatively correlated with RBCs (R2=0.548), Hb (R2=0.559), and GFR (R2=0.466), while it was positively associated with CRP (R2=0.532). The receiver operating characteristic (ROC) curve to assess value of GDF-15 indicated AUC 87.7% ± 0.045 (95% CI 0.78–0.99, p<0.0001, 83.2-22.2% sensitivity and specificity). In multivariate analysis, GDF-15 is independently predictive for diagnosing DN (OR=1.01, 95% CI: 1.00-1.03, P=0.009). Furthermore, each of Hb, GFR, and CRP was found a predictor of GDF-15, (β =-0.42, 2.35, and 0.26). In conclusion, GDF-15 represents a risk biomarker in CKD patients with DN with associated anaemia and inflammation more than in CKD without DN. Additionally, GDF-15 can be a predictive risk stratification factor for achieving the end stage of diabetic kidney disease.