New Test Accurately Predicts End-Stage Renal Disease in Diabetes Patients
A new prognostic tool that assesses the level of tumor necrosis factor receptor 1 (TNFR1) demonstrated a high accuracy for predicting the risk of end stage renal disease in patients with type 1 and type 2 diabetes, according to the results of a new study. 1
In a previous study, the researchers found a connection between TNFR1 and renal function decline in patients with type 1 and type 2 diabetes. Using this research, they sought to develop a practical prognostic test that healthcare providers could use to assess patients and also to determine which patients to enroll in future clinical trials.
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For their study, researchers used history data that included 279 patients with type 1 diabetes and chronic kidney disease (CKD) grouped as the training cohort and 221 patients with type 2 diabetes and CKD grouped as the validation cohort. Participants were followed from 4 to 15 years.
Using classification and regression trees analysis, the researchers found that TNFR1 level over 4.3 ng/ml alone, or TNFR1 level over 2.9 ng/ml to 4.3 ng/ml with an albumin-to-creatinine ratio over 1900 mg/g was the optimal criterion for predicting end stage renal disease. The test had a sensitivity value of 72% and a prognostic value of 81%.
“Remarkably, when we used the TNF receptor to analyze risk of ESRD, the risk was almost identical for both type 1 and type 2 diabetes. This implies that the etiologies are similar,” the researchers concluded. “This is a very important observation because in the medical community, the impression is that the progression to ESRD in type 1 is somehow different from type 2. As a result, many clinical trials do not include patients with type 1.”2
—Melissa Weiss
Reference:
1) Yamanouchi M, Skupien J, Niewczas MA, et al. Improved clinical trial enrollment criterion to identify patients with diabetes at risk of end-stage renal disease [April 7, 2017]. Kidney International. doi:10.1016/j.kint.2017.02.010.
2) New test identifies patients with diabetes who are at high risk of kidney failure [press release]. Boston, MA; Joslin Diabetes Center: April 18, 2017. http://www.joslin.org/news/new-test-identifies-patients-with-diabetes-at-high-risk-of-kidney-failure.html