Article Text
Abstract
Aims Cell-free DNA (cfDNA) is associated with diabetes and cardiovascular diseases. Our study was to evaluate whether serum cfDNA could predict the progression of diabetic kidney disease (DKD).
Methods In this prospective study, a total of 160 patients with DKD were enrolled, and the kidney function was followed up by measurement of estimated glomerular filtration rate (eGFR) and urinary albumin–creatinine ratio (UACR) for three consecutive years. At baseline, concentrations of serum cfDNA were measured. DKD progression was defined as two-continuous decrease in eGFR and changes of UACR from less than 300 mg/g at baseline to higher than 300 mg/g at last follow-up. Regression models were used to analyze associations of serum cfDNA with the DKD progression.
Results In total, 131 patients finished all the follow-up visits. At the end of the study, 64 patients showed decreased eGFR and 29 patients had changes of UACR from less than 300 mg/g at baseline to higher than 300 mg/g at follow-up. At baseline, the progression group had higher serum cfDNA levels than the non-progression group (960.49 (816.53, 1073.65) ng/mL vs 824.51 (701.34, 987.06) ng/mL, p=0.014). Serum cfDNA levels were significantly negatively associated with the 1.5-year eGFR change (r=−0.219 p=0.009) and 3-year eGFR change (r=−0.181, p=0.043). Multivariate logistic analyses showed that after adjustment of age, gender, body mass index, fast plasma glucose, smoking, triglycerides, total cholesterol, duration of diabetes, systolic blood pressure, diabetic retinopathy, eGFR, high sensitivity C-reactive protein, angiotensin receptor blocker/ACE inhibitor usage, with the increase of one SD of serum cfDNA levels, the risk of DKD progression increased by 2.4 times (OR, 2.46; 95% CI 1.84 to 4.89).
Conclusion Serum cfDNA is closely associated with DKD, and it might be a predictor of DKD progression in patients with type 2 diabetes.
- cfDNA
- diabetes
- chronic kidney disease
- prospective study
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Footnotes
XL, RH and TL are joint first authors.
XL and RH contributed equally.
Contributors XL, RH and TL enrolled patients, analyzed the data and drafted the manuscript. CP and JH finished the assay of serum cfDNA. LG followed up patients. QL and SY designed the study and contributed to critical revisions of the article.
Funding This research was supported by National Key Research & Development Plan, major project of precision medicine research (2017YFC0909600,sub-project:2017YFC0909602, 2017YFC0909603), the National Natural Science Foundation of China (81670785, 81870567, 81800731, 81970720, 81700754), Bethune Merck Diabetes Research Foundation (G2018030), Chongqing Outstanding Youth Funds (cstc2019jcyjjq0006) and Outstanding Talents of the First Affiliated Hospital of Chongqing Medical University 2019.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the ethical committee of Chongqing Medical University, and written informed consent was obtained from all patients participating in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The data used to support the findings of this study are available from the corresponding author upon reasonable request.