Kidney (renal) failure is a real threat for people with Type 1 and Type 2 diabetes, and because there is no accurate and noninvasive test available, and it's not clear who will develop the most severe disease until it's too late and the disease is advanced. Two new blood biomarkers usually associated with inflammation could predict the risk of developing kidney disease up to 10 years in advance.
People with diabetes face a range of complications, but diabetic nephropathy is one of the most life-threatening, and can lead to end-stage renal disease (ESRD), needing dialysis or a kidney transplant. To find potential biomarkers, researchers from the Joslin Diabetes Center and Harvard Medical School followed patients with Type 2 diabetes for 8 to 12 years, monitoring their kidney function and whether they went on to develop kidney failure. They found that people who went on to develop ESRD had raised levels of tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) in their blood. In a follow-up study in people with Type 1 diabetes, tracking the same markers was able to pick out the people with early signs of kidney. Overall, high levels of the markers increased the risk of developing kidney complications three- to fivefold, and did not depend on any other clinical characteristics.
"These markers are excellent predictors of early and late renal function decline in patients with diabetes," says senior author Dr. Andrzej Krolewski, section head of Genetics and Epidemiology at Joslin. "Our findings may improve clinical care for patients who are at risk of kidney damage. A diagnostic test to measure TNFRs in blood will be developed soon and available for patients. In the meantime, our findings suggest that mechanisms underlying the association between TNFRs and high risk of renal function decline may be a target for new drug development."
These results show potential and the biomarkers could help doctors predict patients' risk and monitor their progress and their response to treatments. They could also provide biopharma companies with surrogate endpoints for studies, making drug development quicker, as well as suggesting new targets for drug development. It's important to remember that this is still early research and the findings need to be replicated. So although Krolewski says the test may be available "soon," it's not going to be tomorrow.