#3915 RELATIONSHIP BETWEEN URINARY DCR2/CR LEVEL AND POOR PROGNOSIS OF DIABETIC NEPHROPATHY
Authors: Wang Weidong , Chen Jia , He Yani , Chen Kehong 
Published: June 2023

Abstract

Background and Aims
Diabetic kidney disease(DKD) has a high prevalence rate and many complications, and it has become the main reason for the progression of chronic kidney disease to end-stage renal disease (ESRD). At present, some clinical biomarkers, such as urinary albumin / creatinine ratio (ACR), serum creatinine and cystatin C, are of positive significance in evaluating the course of DKD, but these indicators are greatly affected by the state of the body itself, which can no longer meet the clinical needs. Decoy receptor 2 (DcR2) is the transmembrane receptor of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and is a biomarker of cell senescence and apoptosis resistance. Our previous study found that the level of urinary DcR2/Cr is closely related to renal function damage and renal interstitial injury. Considering that there is still a lack of research on predicting the poor prognosis of DKD with related biomarkers, this study detected the level of DcR2/Cr in the urine of patients with DKD for the first time to analyze the relationship between the poor prognosis of DKD and to determine whether urinary DcR2/Cr can be used as an index to predict the poor prognosis of DKD.

Method
A total of 181 inpatients with DKD were collected from the Department of Nephrology of Daping Hospital from 2018 to 2022, of which 121 urine samples were collected. The clinical data of the patients were collected and divided into three quantiles according to the level of urinary DcR2/Cr. Group 1: DcR2/Cr &lt; 321ng / mmol. group 2: 321 ≤ DcR2/Cr ≤ 505ng / mmol. group 3: DcR2/Cr &gt; 505ng / mmol. The adverse prognosis was based on the occurrence of end point events. Multivariate Cox regression analysis was used to evaluate the relationship between urinary DcR2/Cr level and poor prognosis of DKD. ROC curve was used to analyze the value of biomarkers in predicting the poor prognosis of DKD.

Results
With the increase of urinary DcR2/Cr level, the levels of urinary Microalbumin, ACR, NAG, CYC and serum creatinine increased, while urinary creatinine and eGFR decreased gradually. Correlation analysis showed that the level of DcR2/Cr was positively correlated with ACR, cystatin C and NAG, and negatively correlated with eGFR, while DcR2/Cr was positively correlated with IFTA score, renal artery hyaline change score and renal arteriosclerosis score. Cox regression analysis showed that there was a significant correlation between the level of DcR2/Cr and the occurrence of poor prognosis (corrected by the model), and the risk of poor prognosis in the DcR2/Cr3 group was 9.903 times higher than that in the DcR2/Cr1 group. Kaplan-Meier survival curve showed that the higher the level of DcR2/Cr, the worse the prognosis. ROC curve analysis showed that the area under urinary DcR2 curve was the largest (AUC = 0.811), which was higher than ACR, CYC and SCr, and the best intercept value was 389.0ng/mmol.

Conclusion
Urinary DcR2/Cr is superior to ACr, Scr, Cyc and other clinical indexes in predicting the poor prognosis of DKD. It is an effective biomarker for predicting poor prognosis of DKD.