Predictive significance of joint plasma fibrinogen and urinary alpha-1 microglobulin-creatinine ratio in patients with diabetic kidney disease

Abstract

Background Although many biomarkers have high diagnostic and predictive power for diabetic kidney disease (DKD), less studies were performed for the predictive assessment in DKD and its progression with combined blood and urinary biomarkers. This study aims to explore the predictive significance of joint plasma fibrinogen (FIB) concentration and urinary alpha-1 microglobulin-creatinine (α1-MG/CR) ratio in DKD. Methods A total of 234 patients with type 2 diabetes were enrolled, and their clinical and laboratory data were retrospectively assessed. A ROC curve analysis was performed to evaluate the power of plasma FIB and urinary α1-MG/CR ratio for identifying DKD and advanced DKD, respectively. The predictive power for DKD and advanced DKD was analyzed by regression analysis. Results Plasma FIB and urinary α1-MG/CR levels were higher in patients with DKD than with pure T2D (p<0.001). The multivariate-adjusted odds ratios (ORs) were 5.047 (95%CI: 2.276–10.720) and 2.192 (95%CI: 1.539–3.122) (p<0.001) for FIB and α1-MG/CR as continuous variables for DKD prediction, respectively. The optimal cut-off values were 3.21 g/L and 2.11mg/mmol for identifying DKD, and 5.58 g/L and 11.07 mg/mmol for advanced DKD from ROC curves. At these cut-off values, the sensitivity and specificity of joint FIB and α1-MG/CR were 0.95 and 0.92 for identifying DKD, and 0.62 and 0.67 for identifying advanced DKD, respectively. The area under curve was 0.972 (95%CI: 0.948–0.995) (p<0.001) and 0.611, 95%CI: 0.488–0.734) (p>0.05). The multivariate-adjusted ORs for joint FIB and α1-MG/CR at the cut-off values were 214.500 (95%CI: 58.054–792.536) and 3.252 (95%CI: 1.040–10.175) (p<0.05), respectively. Conclusion The present study suggests that joint plasma FIB concentration and urinary α1-MG/CR ratio can be used as a powerful predictor for general DKD, but it is less predictive for advanced DKD.

Urinary α1 microglobulin level is useful for selecting sodium‐glucose transporter 2 inhibitor or metformin for visceral fat reduction in patients with type 2 diabetes

“…Urinary α1MG level is reportedly useful as a predictive marker of diabetic kidney disease 14 . The reduction in urinary α1MG level by empagliflozin has been reported 15 .…”

Coagulation Function and Type 2 Diabetic Kidney Disease: A Real-World Observational Study

“…However, their study did not clarify if these differences remained statistically significant after accounting for confounding variables. Pan et al [ 8 ] identified increased FIB and D-D levels in DKD patients relative to type 2 diabetics without complications. In a more detailed examination of coagulation parameters, they observed no significant association between PT, APTT, TT, and DKD, with only FIB exhibiting a significant correlation postmultiple regression analysis [ 9 ].…”

“…The pathogenesis of DKD is believed to be multifaceted. Numerous studies have underscored the pivotal role of abnormal coagulation, highlighting the hypercoagulable state observed in a significant proportion of DKD patients [ 8 , 9 , 21 , 22 ]. Potential contributors to this state encompass aberrant glucose and lipid metabolism, a microinflammatory milieu, oxidative stress, hypoproteinemia, hemodynamic alterations, and platelet activation in DKD patients.…”

“…Clinically, DKD is recognized as a chronic microvascular complication of diabetes mellitus, and a growing body of evidence underscores its intimate association with coagulation anomalies. Some studies have shown a significant association of coagulation parameters with the onset and progression of DKD, whereas others failed to replicate this association [7][8][9][10]. For instance, a cross-sectional investigation from central China indicated that coagulation markers such as FIB, FDP, D-D, APTT, and TT were notably elevated in DKD patients compared to those devoid of diabetic complications [7].…”