Abstract
Background
Chronic low-grade inflammation is considered one of the major mechanisms for the progression of diabetic kidney disease. We investigated the prognostic value of circulating soluble tumor necrosis factor receptor 2 (sTNFR2) for early nephropathy in patients with type 2 diabetes.
Materials and methods
A total of 346 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 were followed up for a median of 4 years. Renal outcomes were defined as a composite of either or both a > 30% decline in the eGFR and/or albuminuria stage progression determined with consecutive tests.
Results
Sixty-nine patients developed renal composite events. Serum concentrations of sTNFR2 were strongly associated with the risk of renal function decline and progressive changes in albuminuria. Through a receiver operating characteristic curve analysis, a serum sTNFR2 level of 1.608 ng/mL was adopted as the discriminator value for predicting renal outcomes (area under the curve 0.61, 95% confidence interval 0.54–0.68, p = 0.005), yielding a sensitivity of 73.9% and a specificity of 48.7%. The association of sTNFR2 levels ≥ 1.608 ng/mL to renal outcomes was significant after adjusting for relevant variables (hazard ratio 1.95, 95% confidence interval 1.01–3.74, p = 0.046) and remained consistent across subgroups stratified by age, sex, systolic blood pressure, eGFR, albuminuria, and the use of renin-angiotensin system blockers.
Conclusions
Higher circulating levels of sTNFR2 are independently associated with an eGFR decline and progressive albuminuria in patients with type 2 diabetes.
Higher Production of Tumor Necrosis Factor (TNF) Elicited by a Biological Response Modifier (BRM) in Aging Mice.