TY - JOUR
T1 - Urine matrix metalloproteinase-7 and risk of kidney disease progression and mortality in type 2 diabetes
AU - Afkarian, Maryam
AU - Zelnick, Leila R.
AU - Ruzinski, John
AU - Kestenbaum, Bryan
AU - Himmelfarb, Jonathan
AU - De Boer, Ian H.
AU - Mehrotra, Rajnish
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Aims The renin-angiotensin-aldosterone system (RAAS), bone morphogenetic protein (BMP) and WNT pathways are dysregulated in diabetic kidney disease (DKD). Urine excretion of angiotensinogen, gremlin-1 and matrix metalloproteinase-7 (MMP-7), components of the RAAS, BMP and WNT pathways, respectively, is increased in DKD. We asked if this increase is associated with subsequent progression to end-stage renal disease (ESRD) or death. Methods Using time-to-event analyses, we examined the association of baseline urine concentration of these proteins with progression to ESRD or death in a predominantly Mexican-American cohort with type 2 diabetes and proteinuric DKD (n = 141). Results Progression to ESRD occurred for 38 participants over a median follow-up of 3.0 years; 39 participants died over a median follow-up of 3.6 years. Urine MMP-7 and gremlin-1 were associated with increased risk of ESRD after adjustment for demographic and clinical covariates. Angiotensinogen showed a U-shaped relationship with ESRD, with the middle tertile associated with lowest risk of ESRD. After additional adjustment for glomerular filtration rate and albuminuria, all associations with ESRD lost significance. Only urine MMP-7 was associated with mortality, and this association remained robust in the fully adjusted model with a Hazard ratio of 3.59 (95% confidence interval 1.31 to 9.85) for highest vs. lowest tertile. Serum MMP-7 was not associated with mortality and did not attenuate the association of urine MMP-7 with mortality (HR 4.03 for highest vs. lowest urine MMP-7 tertile). Conclusions Among people with type 2 diabetes and proteinuric DKD, urine MMP-7 concentration was strongly associated with subsequent mortality.
AB - Aims The renin-angiotensin-aldosterone system (RAAS), bone morphogenetic protein (BMP) and WNT pathways are dysregulated in diabetic kidney disease (DKD). Urine excretion of angiotensinogen, gremlin-1 and matrix metalloproteinase-7 (MMP-7), components of the RAAS, BMP and WNT pathways, respectively, is increased in DKD. We asked if this increase is associated with subsequent progression to end-stage renal disease (ESRD) or death. Methods Using time-to-event analyses, we examined the association of baseline urine concentration of these proteins with progression to ESRD or death in a predominantly Mexican-American cohort with type 2 diabetes and proteinuric DKD (n = 141). Results Progression to ESRD occurred for 38 participants over a median follow-up of 3.0 years; 39 participants died over a median follow-up of 3.6 years. Urine MMP-7 and gremlin-1 were associated with increased risk of ESRD after adjustment for demographic and clinical covariates. Angiotensinogen showed a U-shaped relationship with ESRD, with the middle tertile associated with lowest risk of ESRD. After additional adjustment for glomerular filtration rate and albuminuria, all associations with ESRD lost significance. Only urine MMP-7 was associated with mortality, and this association remained robust in the fully adjusted model with a Hazard ratio of 3.59 (95% confidence interval 1.31 to 9.85) for highest vs. lowest tertile. Serum MMP-7 was not associated with mortality and did not attenuate the association of urine MMP-7 with mortality (HR 4.03 for highest vs. lowest urine MMP-7 tertile). Conclusions Among people with type 2 diabetes and proteinuric DKD, urine MMP-7 concentration was strongly associated with subsequent mortality.
KW - Angiotensinogen
KW - Diabetic kidney disease
KW - Gremlin-1
KW - MMP-7
KW - Mortality
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84948675948&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84948675948&partnerID=8YFLogxK
U2 - 10.1016/j.jdiacomp.2015.08.024
DO - 10.1016/j.jdiacomp.2015.08.024
M3 - Article
C2 - 26412030
AN - SCOPUS:84948675948
VL - 29
SP - 1024
EP - 1031
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
SN - 1056-8727
IS - 8
ER -