Kidney Week

Abstract: SA-PO320

Application of a Validated Prognostic Protein Biomarker Test for Kidney Decline in Type 2 Diabetes to Type 1 Diabetes

Session Information

• Diabetic Kidney Disease: Clinical Pathology, Diagnostic and Treatment Advances
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Peters, Kirsten E., Proteomics International, Perth, Western Australia, Australia

Kirsten E. Peters, PhD

• Davis, Wendy A., The University of Western Australia, Perth, Western Australia, Australia

Wendy A. Davis, PhD, MPH

• Bringans, Scott David, Proteomics International, Perth, Western Australia, Australia

Scott David Bringans, PhD

• Lui, James Kwok Ching, Proteomics International, Perth, Western Australia, Australia

James Kwok Ching Lui, MSc, PhD

• Lumbantobing, Tasha S. C., Proteomics International, Perth, Western Australia, Australia

Tasha S. C. Lumbantobing

• Davis, Timothy, The University of Western Australia, Perth, Western Australia, Australia

Timothy Davis, MD

• Lipscombe, Richard, Proteomics International, Perth, Western Australia, Australia

Richard Lipscombe

Background

Population-based studies have shown that the risk of chronic kidney disease (CKD) appears greater in type 1 diabetes (T1D) versus type 2 diabetes (T2D) across all age strata, and there is evidence of relative underutilization of renoprotective therapies in T1D. These observations argue for validated tests that reliably identify the risk of progressive renal disease at an early stage in T1D and pre-empt preventive management strategies. PromarkerD is a validated blood test developed for predicting renal decline over four years in T2D. This study assessed whether PromarkerD has similar clinical utility as a prognostic test in T1D.

Methods

PromarkerD scores were measured at baseline in 137 participants with T1D from the community-based Fremantle Diabetes Study. Plasma protein concentrations (ApoA4, CD5L, IGFBP3) measured by ELISA were combined with the concomitant age, serum HDL-cholesterol and eGFR to provide PromarkerD scores. Scores were categorised as low-, moderate- or high-risk as determined by pre-specified cut-offs. Renal decline was defined as incident CKD (eGFR <60 mL/min/1.73m² in people above this at baseline) or an eGFR decline of ≥30% over four years. Performance was assessed using the area under the receiver operating characteristic curve (AUC).

Results

At baseline, the 137 participants (mean age 45 years, 53% males, median diabetes duration 20 years) with PromarkerD classifying 83% low-risk, 10% moderate-risk and 7% high-risk for renal function decline in the next four years. Of these, 92 (67%) had renal function assessed at the four-year review, with 9 (9.8%) developing outcomes. The biomarkers ApoA4 and CD5L were significantly elevated at baseline in the people with prespecified renal outcomes while IGFBP3 showed no significant difference. The PromarkerD test scores were substantially higher in those with incident renal outcomes; the AUC was 0.93 (95% CI 0.87–0.99), with sensitivity 78%, specificity 98%, PPV 50% and NPV 97%.

Conclusion

The present data suggest that PromarkerD has strong clinical utility in identifying people with T1D at risk of adverse renal outcomes. Further validation studies are underway to confirm this promising performance of the PromarkerD test for predicting CKD in T1D, as has previously been shown for T2D.

Funding

• Commercial Support – Proteomics International