New Test Identifies Patients with Diabetes Who Are At High Risk of Kidney Failure

Researchers from Joslin Diabetes Center have developed a test that accurately predicts the risk of end stage renal disease (ESRD) in patients with diabetes.  The findings are published online (April 7, 2017) on the Kidney International website ahead of print publication.

Andrzej S. Krolewski, M.D., Ph.D., Head of the Section on Genetics & Epidemiology at Joslin Diabetes Center and Professor of Medicine at Harvard Medical School.

Current Testing for Kidney Failure

In the past, doctors have relied mostly on two tests — urinary albumin to creatinine ratio (ACR) and estimated glomerular filtration rate — to identify those at higher risk of kidney failure and also to select patients for clinical trials. But researchers say that those criteria miss a large number of patients who are at high risk of the disease. They also fail to predict accurately time of onset of ESRD.



In 2012, Dr. Krolewski and his team found a link between tumor necrosis factor receptor 1 (TNFR1) and worsening renal function in type 1 and type 2 diabetes. Building on this breakthrough research, the researchers tried to find a practical prognostic test that doctors could use to assess care and enroll patients in clinical trials.

For this study, the researchers used data from a population of patients with both diabetes and chronic kidney disease (stage 3 and 4) enrolled in follow up studies at the Joslin Diabetes Center and followed for 4 to 15 years.

Dr. Krolewski and colleagues found that specific values of two biomarkers — circulating level of TNFR1 and ACR combined — indicated high risk of ESRD. They found that the prognostic test for type 2 diabetes was similar to type 1. Overall the tests had a sensitivity value (detecting those at risk) of 72 percent and positive prognostic value (detecting those who developed ESRD in three years) of 81 percent.


Future Applications

“Currently, about 80 percent of patients in these clinical trials provide no useful information,” says Dr. Krolewski. “If our criterion is used in the recruitment of patients, you will not need two or three thousand patients for a clinical trial, you will only need 400 patients.”

“Dr. Krolewski’s exciting new prognostic tool will dramatically reduce the cost of clinical trials and help expand the pipeline of therapies for people with diabetic nephropathy,” said Marlon Pragnell, JDRF Senior Scientific Program Manager.  “JDRF is pleased to have supported this work, and we look forward to the tool being used in future clinical trials.”

This discovery also opens the door to using the TNF receptor to develop new medications.

Source (modified for readability):

Sripathi R. Kethu, M.D. FACG.
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Sripathi R. Kethu, M.D. FACG.

Dr Kethu is a Gastroenterologist in Dallas.

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