Highlights
- High levels of TNF receptors in the blood increased diabetes patients' risk of developing kidney problems by three- to five-fold a decade later.
- Measuring blood levels of TNF receptors may help predict which patients' kidneys are in jeopardy, and targeting TNF receptors may help protect them.
- Half a million people in the U.S. have kidney failure and require dialysis or a kidney transplant, and 44% of these cases are due to diabetes.
Washington, DC (January 19, 2012) — Levels of certain blood proteins indicate which diabetes patients will likely develop life-threatening kidney problems in the future, according to two studies appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results could help physicians protect the kidney health of patients with diabetes years before any visible signs of trouble arise.
Kidney failure is one of the most life-threatening complications of diabetes, and almost half of patients who receive dialysis treatments need them because their kidneys have become damaged from diabetes.
Unfortunately, physicians don't have an accurate, non-invasive way to determine which diabetes patients are most likely to develop kidney problems. Because recent research indicates that inflammation may contribute to kidney injury among patients with diabetes, Andrzej Krolewski, MD (Joslin Diabetes Center and Harvard Medical School), Monika Niewczas, MD, PhD (Joslin Diabetes Center, Harvard Medical School, and Medical University of Warsaw, in Poland), and their colleagues wondered whether certain markers of inflammation might signal when a patient's kidneys are in jeopardy.
The investigators measured several dozens of inflammation markers in the blood and urine of more than a thousand patients with type 1 and type 2 diabetes and then monitored the patients' kidney health for more than a decade. They identified two extremely powerful markers—tumor necrosis factor (TNF) receptors 1 and 2—that increased patients' risk of developing kidney disease by three- to five-fold when found at high levels in the blood 10 years earlier. A diagnostic test to measure blood levels of TNF receptors is currently in development and should be available in the clinic soon.
The findings also go beyond prediction and suggest that targeting TNF receptors may be an effective way to prevent or slow kidney function decline. "Learning about mechanisms that regulate blood levels of TNF receptors and the way that high levels of these receptors cause kidney injury will accelerate the search for new therapeutic targets against kidney disease in individuals with diabetes and possibly in those without diabetes," said Dr. Krolewski.
Study co-authors include Tomohito Gohda, MD, PhD (Joslin Diabetes Center and Juntendo University School of Medicine, in Tokyo, Japan); Jan Skupien, MD, PhD, Adam Smiles, William Walker, Alessandro Doria, MD, PhD, James Warram, MD, DSc, Linda Ficociello, DSc, Amanda Johnson, Gordon Crabtree (Joslin Diabetes Center); John Eckfeldt, MD, PhD (University of Minnesota, Minneapolis); Florencia Rosetti, MD, Xavier Cullere, PhD, Tanya Mayadas, PhD (Brigham and Women's Hospital).
Disclosures: The authors reported no industry-related financial disclosures. These studies were supported by funding from Juvenile Diabetes Research Foundation and National Institutes of Health, as well as other fellowships and grants.
The articles, entitled "Circulating TNF Receptors 1 and 2 Predict ESRD in Type 2 Diabetes" and "Circulating TNF Receptors 1 and 2 Predict Stage 3 CKD in Type 1 Diabetes," will appear online at http://jasn.asnjournals.org/ on January 19, 2012, doi: 10.1681/ASN.2011060628 and doi: 10.1681/ASN.2011060627.
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Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
Journal
Journal of the American Society of Nephrology