title: Circulating bone morphogenetic protein-7 and transforming growth factor-β1 are better predictors of renal end points in patients with type 2 diabetes mellitus.
abstract: Albuminuria and a reduced glomerular filtration rate are conventional predictors of a future decline in kidney function in patients with type 2 diabetes mellitus. Using a nested case-control study we assessed whether circulating transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-7 (BMP-7) levels more accurately predict renal end points than the conventional markers. Cases were defined as those who developed a renal end point (doubling of serum creatinine to at least 200 μmol/l, the need for renal replacement therapy, or death due to renal disease) during the study. Using propensity scoring, two controls were selected for each of 281 cases. Participants who developed renal end points had significantly higher total TGF-β1, lower BMP-7 levels, and a higher total TGF-β1 to BMP-7 ratio at baseline. A graded increase in risk was found in individuals with lower BMP-7 levels (odds ratio 24.07, for the lowest to the highest tertile), or significantly higher TGF-β1 levels (odds ratio for the highest to the lowest tertile, 8.43). The area under the receiver operating characteristic curve (c-statistic) for the conventional predictors was 0.73. Using BMP-7 and total and active TGF-β1, the c-statistic was 0.94 (significantly higher to conventional predictors). Thus, our results suggest these novel kidney markers are better predictors of renal progression than the conventional predictors in patients with type 2 diabetes mellitus.
authors.affiliation: Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Muh Geot
authors.initials: MG
authors.lastname: Wong
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.forename: Dania
authors.initials: D
authors.lastname: Yaghobian Azari
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Pavel
authors.initials: P
authors.lastname: Hamet
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Mark
authors.initials: M
authors.lastname: Cooper
authors.forename: Carol A
authors.initials: CA
authors.lastname: Pollock
mesh_terms: D000368:Aged; D015415:Biomarkers; D055419:Bone Morphogenetic Protein 7 / Q000097:blood*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood*; D008297:Male; D008875:Middle Aged; D053773:Transforming Growth Factor beta1 / Q000097:blood*
chemical_list: D015415:Biomarkers; D055419:Bone Morphogenetic Protein 7; D053773:Transforming Growth Factor beta1