Biomarkers of Kidney Disease Progression Have “Transcendent Signals” Across Subtypes, Says Dr Steven Coca

Biomarkers of kidney disease progression are agnostic to underlying diabetes, although some are slightly stronger in patients with diabetes, explained Steven Coca, DO, MS, professor of medicine, associate chair for clinical and translation research for the Department of Internal Medicine, and director of clinical research for the Division of Nephrology, Icahn School of Medicine at Mount Sinai.

Transcript

When looking at biomarkers regarding kidney disease progression, is there a difference between those that have prognostic significance for patients with vs without diabetes?

There's been a host of blood- and urine-based biomarkers that have been examined in a variety of settings. And the short answer is that most of these markers seem to be agnostic to whether there's underlying diabetes or not. They are really ascertaining kidney health or kidney injury.

That being said, some studies have shown some of the markers to be slightly stronger in those with diabetes, whether it be type 1 or type 2. But in general, both work that I've been involved with, with my colleagues across various consortia, and that others are doing are showing that some of these markers that keep coming up in the diabetic setting—whether it be the soluble TNF [tumor necrosis factor] receptors, whether it be KIM-1 [Kidney Injury Molecule-1], whether it be urinary EGF [epidermal growth factor], urinary MCP-1 [monocyte chemoattractant protein-1], uromodulin, suPAR [soluble urokinase-type plasminogen activator receptor, the list goes on and on—by and large, they can probably prognosticate patients in the outpatient setting with type 1 and type 2 diabetes for the risk of progression and nondiabetic chronic kidney disease. There's even some data that some of these markers have prognostic significance in glomerulonephritis. There's data that it can work during or after acute kidney injury to determine the risk of future incident CKD [chronic kidney disease] or progressive CKD.

So, it's really an exciting time to determine, again, which is the ideal set of markers, in which clinical scenario, in which subtype of patients, but I'm glad to see that many of the markers have these transcendent signals across diabetes, nondiabetes, and other subtypes of CKD.