Association of circulating biomarkers (Adrenomedullin, TNFR1, and NT-proBNP) with renal function decline in patients with type 2 diabetes: A French prospective cohort

Abstract

OBJECTIVE We explored the prognostic value of three circulating candidate biomarkersd midregional-proadrenomedullin (MR-proADM), soluble tumor necrosis factor receptor 1 (sTNFR1), and N-Terminal prohormone brain natriuretic peptide (NT-proBNP)dfor change in renal function in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Outcomes were defined as renal function loss (RFL), 40% decline of estimated glomerular filtration rate (EGFR) from baseline, and rapid renal function decline (RRFD), absolute annual EGFR slope < 0.0001; 1.33 [1.14-1.55], P = 0.0003; and 1.22 [1.07-1.40], P = 0.004, respectively) and RRFD (adjusted odds ratio 1.56 [95% CI 1.7-2.09], P = 0.003; 1.72 [1.33-2.22], P < 0.0001; and 1.28 [1.03-1.59], P = 0.02, respectively). The combination of the three biomarkers yielded the highest discrimination (difference in C-statistic = 0.054, P < 0.0001; 0.067, P < 0.0001 for RFL; and 0.027, P < 0.0001 for RRFD). CONCLUSIONS In addition to established risk factors, MR-proADM, sTNFR1, and NT-proBNP improve risk prediction of loss of renal function in patients with type 2 diabetes .