6 Sept 2023 • Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality, however, very few functional biomarkers are available for high risk patients. Several patients who eventually develop ESKD are non - proteinuric when impaired GFR is recognized.

Identifying the patients at risk for progression in the early stages of disease is crucial for better clinical outcomes because non proteinuric or non-macroalbuminuric DKD accounts for >40% of prevalent ESKD in patients with type 2 diabetes and 75% of prevalent CKD (GFR 60 mL/min/ 1.73m2).

Establishing novel biomarkers that can predict progression and represent biologically relevant pathways in DKD could enhance the care of patients with diabetes. With an aim to improve the prediction of ESKD, researchers investigated whether urine levels of adenine could predict kidney disease in people with diabetes, since exogenous adenine had been found to cause kidney failure in mice, rats, and dogs

To learn more about the correlation of adenine levels to kidney failure, the researchers analyzed urine sample data from over 1,200 patients with diabetes and impaired kidney function from three international research cohorts:

• African-American, Hispanic, and Caucasian individuals in the U.S.
• American Indian individuals
• an Asian cohort consisting mainly of Chinese, Asian Indians, and Malay populations In each of the cohorts, the researchers found higher levels of adenine linked to higher rates of kidney failure and elevated adenine levels were further linked to a higher risk of all-cause mortality.

However, further investigations are required to determine whether endogenous adenine production contributes to the progression of DKD or just serves as a biomarker.

These findings also suggest an entirely novel target for the development of therapeutics that might reduce progression to kidney failure.

Source: JCI | Read full story