Elevated circulating pigment epithelium-derived factor predicts the progression of diabetic nephropathy in patients with type 2 diabetes

Abstract

Context: Pigment epithelium-derived factor (PEDF), a circulating glycoprotein with antiangiogenic, antioxidative, and anti-inflammatory properties, protects against diabetic nephropathy (DN) in animal models. Objective: We investigated whether circulating PEDF predicted the progression of DN in a 4-year prospective study. Design, Setting, and Participants: BaselineplasmaPEDFlevelsweremeasuredintype2diabetic subjects recruited from the Hong Kong West Diabetes Registry. The role of PEDF in predicting chronic kidney disease (CKD) and albuminuria progression was analyzed using Cox regression analysis. Main Outcome Measure: We evaluated CKD progression, defined as deterioration in CKD staging and a25%or greater drop in estimated glomerular filtration rate (eGFR) according to International Society of Nephrology statements. Conclusions: Elevated PEDF levelsmayrepresent a compensatory change in type 2 diabetic patients with renal disease and appear to be a useful marker for evaluating the progression of DN. Results: At baseline, plasma PEDF levels increased progressively with CKD staging (P for trend 60 mL/min/1.73 m2 (n = 462) at baseline (hazard ratio = 2.75; 95% confidence interval =1.01-7.49; P