A Novelty Biomarker Ins60/ApoA for Predicting Diabetic Kidney Disease in Newly Diagnosed Type 2 Diabetes: A Pilot Study

Binbin Pan^1*Jin Sun²Mengqing Ma¹Hao Zhang¹Hao Hu²Yuanyuan Liu²wanwan Zhang²Xin Wan¹

• ¹Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
• ²Department of Endocrinology, Xuzhou First People’s Hospital, the affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China

We performed this cross-sectional study to explore probable biomarkers for predicting diabetic kidney disease (DKD) in newly diagnosed type 2 diabetes mellitus (T2DM).A total of 623 patients from Xuzhou first hospital and Nanjing First Hospital were recruited according to the case records system. Patients were grouped via the ratio of albuminuria & creatinine (ACR) (<30mg/g, 30>=mg/g). Biomarkers in different ACR groups were compared by independent sample T-test. Correlation analysis was determined by Pearson or Spearman analysis and binary logistic regression. The receiver operating characteristics (ROC) curve was performed to elucidate the prediction effect of biomarkers on DKD.The levels of total cholesterol, glycated hemoglobin (HbA1c), fast C-peptide, fast insulin and prevalence of hypertension were higher while levels of red blood cell counts (RBC), hemoglobin, ApoA and free triiodothyronine were lower in ACR>=30mg/g group. There was a negative correlation between ACR>=30mg/g and RBC, hemoglobin, albumin, NAFLD (r = -0.094, p =0.02; r = -0.130, p = 0.001; r=-0.137, p =0.001; r = -0.097, p = 0.018) , while positively correlated with high-density lipoprotein, fast blood glucose, hypertension and ratio of 60-minute insulin postprandial and serum apolipoprotein(a) (Ins60/ApoA) were observed (r = 0.134, p =0.001; r = 0.120, p = 0.003; r=0.131, p =0.001; r = 0.359, p = 0.001).. Further, binary logistic regression showed lnIns60/ApoA was an independent influence factor for ACR>=30mg/g. After adjusting for age, gender, hypertension, non-alcoholic fatty liver disease (NAFLD), hemoglobin, albumin, smoking history, alcohol drink history and body mass index (BMI), lnIns60/ApoA was an independent influence factors for ACR>=30mg/g(OR = 2.778, p =0.015). The area under the ROC curve was 0.741 (95% CI:0.629-0.854, p = 0.001) for ACR>=30mg/g. The analysis of ROC curves revealed a best cut-off for ACR was 22.42 mg/g and yielded a sensitivity of 67.6% and a specificity of 72.1%.Ratio of Ins60/ApoA could be used as an alternative biomarker for predicting DKD in newly diagnosed T2DM patients.