title: Predictive effects of urinary liver-type fatty acid-binding protein for deteriorating renal function and incidence of cardiovascular disease in type 2 diabetic patients without advanced nephropathy.
abstract: OBJECTIVE
  To improve prognosis, it is important to predict the incidence of renal failure and cardiovascular disease in type 2 diabetic patients before the progression to advanced nephropathy. We investigated the predictive effects of urinary liver-type fatty acid-binding protein (L-FABP), which is associated with renal tubulointerstitial damage, in renal and cardiovascular prognosis.
  
  
  METHODS
  Japanese type 2 diabetic patients (n = 618) with serum creatinine ≤1.0 mg/dL and without overt proteinuria were enrolled between 1996 and 2000 and followed up until 2011. Baseline urinary L-FABP was measured with an enzyme-linked immunosorbent assay. The primary end points were renal and cardiovascular composites (hemodialysis, myocardial infarction, angina pectoris, stroke, cerebral hemorrhage, and peripheral vascular disease). The secondary renal outcomes were the incidence of a 50% decline in estimated glomerular filtration rate (eGFR), progression to an eGFR <30 mL/min/1.73 m(2), and the annual decline rate in eGFR.
  
  
  RESULTS
  During a 12-year median follow-up, 103 primary end points occurred. The incidence rate of the primary end point increased in a stepwise manner with increases in urinary L-FABP. In Cox proportional hazards analysis, the adjusted hazard ratio in patients with the highest tertile of urinary L-FBAP was 1.93 (95% CI 1.13-3.29). This relationship was observed even when analyzed separately in normoalbuminuria and microalbuminuria. Patients with the highest tertile of urinary L-FABP also demonstrated a higher incidence of the secondary renal outcomes.
  
  
  CONCLUSIONS
  Our results indicate that urinary L-FABP may be a predictive marker for renal and cardiovascular prognosis in type 2 diabetic patients without advanced nephropathy.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan. araki@belle.shiga-med.ac.jp
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Araki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Koya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugaya
authors.forename: Keiji
authors.initials: K
authors.lastname: Isshiki
authors.forename: Shinji
authors.initials: S
authors.lastname: Kume
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kashiwagi
authors.forename: Takashi
authors.initials: T
authors.lastname: Uzu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maegawa
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000652:urine*; D003928:Diabetic Nephropathies / Q000652:urine*; D004797:Enzyme-Linked Immunosorbent Assay; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000209:etiology* / Q000652:urine*; D008297:Male; D008875:Middle Aged
chemical_list: D050556:Fatty Acid-Binding Proteins