title: Serum amyloid a and risk of death and end-stage renal disease in diabetic kidney disease.
abstract: To determine if serum levels of serum amyloid A (SAA) predict death and end-stage renal disease in a cohort of people with diabetic kidney disease.
  
  
  
  In a longitudinal cohort study of 135 participants with type 2 diabetes and diabetic kidney disease, serum samples were assayed for SAA. Censored time-to-event analyses in Cox-proportional hazard models were utilized to assess SAA as a predictor of the primary outcome of death and end-stage renal disease.
  
  
  
  Participants were 73% Mexican-American (99/135) and 55% men (75/135), with a mean±SD age of 57±7.5years. At baseline, participants had hemoglobin A1c of 8.6±2.3%, systolic blood pressure of 153±27mm Hg, body mass index of 31±9kg/m2, median urine-albumin-to-creatinine ratio of 1861mg/g (interquartile range 720-3912mg/g), and estimated glomerular filtration rate of 55.7±22.3ml/min/1.73m2. Over a median duration of follow-up of 3.5years, 44% (60/135) of participants experienced a primary outcome event. The hazards ratio for the primary outcome was 3.03 (95% CI 1.43-6.40, p=0.003) in the highest (>1.0 μg/ml) compared to the lowest (<0.55 μg/ml) SAA tertile in a model adjusted for urine-albumin-to-creatinine ratio, estimated glomerular filtration rate, age, sex, and race/ethnicity. Addition of SAA as a covariate improved the model C-statistic (Δ c=0.017).
  
  
  
  In a longitudinal cohort study of participants with type 2 diabetes and DKD, higher levels of serum SAA predicted higher risk of death and ESRD. SAA is a promising targetable biomarker for DKD.
authors: Providence Medical Research Center, Providence Health Care. Electronic address: Brad.dieter@providence.org.
authors: Brad P
authors: BP
authors: Dieter
authors: Providence Medical Research Center, Providence Health Care; Washington State University.
authors: Sterling M
authors: SM
authors: McPherson
authors: University of Washington; Nephrology Division, Kidney Research Institute.
authors: Maryam
authors: M
authors: Afkarian
authors: Washington State University Elson S. Floyd College of Medicine; University of Washington; Nephrology Division, Kidney Research Institute.
authors: Ian H
authors: IH
authors: de Boer
authors: University of Washington.
authors: Rajnish
authors: R
authors: Mehrotra
authors: Washington State University Elson S. Floyd College of Medicine.
authors: Robert
authors: R
authors: Short
authors: Washington State University Elson S. Floyd College of Medicine.
authors: Celestina
authors: C
authors: Barbosa-Leiker
authors: Providence Medical Research Center, Providence Health Care; University of Washington.
authors: Radica Z
authors: RZ
authors: Alicic
authors: Providence Medical Research Center, Providence Health Care.
authors: Rick L
authors: RL
authors: Meek
authors: Providence Medical Research Center, Providence Health Care; University of Washington; Nephrology Division, Kidney Research Institute.
authors: Katherine R
authors: KR
authors: Tuttle
mesh_terms: D000368:Aged; D002140:California; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000097:blood / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D012307:Risk Factors; D000685:Serum Amyloid A Protein / Q000032:analysis*
chemical_list: D000685:Serum Amyloid A Protein
keywords: Biomarkers; Chronic kidney disease; Diabetes; Inflammation; Risk-stratification