title: Elevated circulating pigment epithelium-derived factor predicts the progression of diabetic nephropathy in patients with type 2 diabetes.
abstract: BACKGROUND
  Pigment epithelium-derived factor (PEDF), a circulating glycoprotein with antiangiogenic, antioxidative, and anti-inflammatory properties, protects against diabetic nephropathy (DN) in animal models.
  
  
  OBJECTIVE
  We investigated whether circulating PEDF predicted the progression of DN in a 4-year prospective study.
  
  
  METHODS
  Baseline plasma PEDF levels were measured in type 2 diabetic subjects recruited from the Hong Kong West Diabetes Registry. The role of PEDF in predicting chronic kidney disease (CKD) and albuminuria progression was analyzed using Cox regression analysis.
  
  
  METHODS
  We evaluated CKD progression, defined as deterioration in CKD staging and a 25% or greater drop in estimated glomerular filtration rate (eGFR) according to International Society of Nephrology statements.
  
  
  RESULTS
  At baseline, plasma PEDF levels increased progressively with CKD staging (P for trend <.001; n = 1136). Among 1071 subjects with baseline CKD stage ≤ 3, plasma PEDF levels were significantly higher in those with CKD progression (n = 171) during follow-up than those without (P < .001). Baseline PEDF was independently associated with CKD progression (hazard ratio = 2.76; 95% confidence interval = 1.39-5.47; P = .004), adjusted for age, sex, waist circumference, diabetes duration, hemoglobin A1c, systolic blood pressure, use of antihypertensive drugs, C-reactive protein, and eGFR. Elevated baseline PEDF was also associated with the development of microalbuminuria/albuminuria in a subgroup with normoalbuminuria and eGFR >60 mL/min/1.73 m(2) (n = 462) at baseline (hazard ratio = 2.75; 95% confidence interval = 1.01-7.49; P < .05), even after adjustment for potential confounders.
  
  
  CONCLUSIONS
  Elevated PEDF levels may represent a compensatory change in type 2 diabetic patients with renal disease and appear to be a useful marker for evaluating the progression of DN.
authors.affiliation: Department of Medicine (E.H., C.-Y.Y., P.C.H.L., Y.-C.W., C.H.Y.F., W.-S.C., A.X., K.S.L.L., Queen Mary Hospital; Research Centre of Heart, Brain, Hormones, and Healthy Aging (E.H., A.X., K.S.L.L.); and State Key Laboratory of Pharmaceutical Biotechnology (A.X., K.S.L.L.), The University of Hong Kong, Hong Kong, China.
authors.forename: Elaine
authors.initials: E
authors.lastname: Hui
authors.forename: Chun-Yip
authors.initials: CY
authors.lastname: Yeung
authors.forename: Paul C H
authors.initials: PC
authors.lastname: Lee
authors.forename: Yu-Cho
authors.initials: YC
authors.lastname: Woo
authors.forename: Carol H Y
authors.initials: CH
authors.lastname: Fong
authors.forename: Wing-Sun
authors.initials: WS
authors.lastname: Chow
authors.forename: Aimin
authors.initials: A
authors.lastname: Xu
authors.forename: Karen S L
authors.initials: KS
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood*; D018450:Disease Progression; D005136:Eye Proteins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D015843:Serpins / Q000097:blood*; D000099174:Pigment Epithelium-Derived Factor
chemical_list: D005136:Eye Proteins; D009414:Nerve Growth Factors; D015843:Serpins; D000099174:Pigment Epithelium-Derived Factor