Metabolites linked to renal decline, time to ESRD in T1DM
Monika A. Niewczas, M.D., Ph.D., from the Joslin Diabetes Center in Boston, and colleagues examined serum metabolomic profiles associated with variation in renal function decline in 158 patients with T1D with proteinuria and chronic kidney disease stage 3. Participants were followed for 11 years to determine the estimated glomerular filtration rate slopes and to ascertain time to ESRD onset.
The researchers detected 110 amino acids and purine and pyrimidine metabolites in at least 80 percent of participants. There was an association for serum levels of seven modified metabolites (C-glycosyltryptophan, pseudouridine, O-sulfotyrosine, N-acetylthreonine, N-acetylserine, N6-carbamoylthreonyladenine, and N6-acetyllysine) with renal function decline and time to ESRD (P < 0.001), which was independent of relevant clinical covariates. The significant metabolites correlated with one another and with tubular injury indices.
"This prospective cohort study in participants with T1D, proteinuria, and impaired renal function at baseline demonstrated that patients with increased circulating levels of certain modified metabolites experience faster renal function decline, leading to ESRD," the authors write. "Whether some of these candidate metabolites are risk factors or just prognostic biomarkers of progression to ESRD in T1D needs to be determined."
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