A 7- to 15-year longitudinal study of 358 diabetics has linked 3 proteins in blood with a slower progression of diabetic kidney disease and progressive kidney failure. The results from Zaipul Md Dom and colleagues suggest that the proteins could help researchers identify diabetics most at risk of kidney damage, potentially enabling earlier interventions and treatment. Despite advancements in blood sugar control and kidney therapies, patients with type 1 or type 2 diabetes still face a high risk of diabetic kidney disease. This condition can eventually progress to end-stage kidney disease, but some patients show slower kidney decline than others. In recent years, scientists have focused on understanding why some individuals progress at slower rates and whether they might harbor proteins that protect the kidneys from the effects of diabetes. As part of the Joslin Kidney study, Md Dom et al. followed two groups of patients with type 1 or type 2 diabetes and varying degrees of diabetic kidney disease (358 total) for between 7 to 15 years. While analyzing more than 1,000 proteins in the patients' plasma, the researchers discovered that patients who progressed slowly had higher amounts of the proteins ANGPT1, TNFSF12, and FGF20. The team confirmed this protective link in an independent group of 294 type 1 diabetics; they also found that FGF20 was elevated in healthy, non-diabetic parents of type 1 diabetics who remained free of kidney complications. If validated in larger studies, this finding "could have a profound implication in future research on determinants of progressive renal decline in [type 1 diabetes]," the authors say. However, they caution that more studies are necessary to confirm a causal link between the 3 proteins and protection from diabetic kidney disease.
Science Translational Medicine