In Diabetes, TNF Receptors Indicate Risk for Renal Decline

Blood levels of two receptors that bind to tumor necrosis factoralpha (TNF ) strongly predict early and late stages of kidney function decline in patients with type 1 and type 2 diabetes, reported two studies published online ahead of print by the Journal of the American Society of Nephrology. Type 1 diabetes patients with the highest concentrations of tumor necrosis factor receptor 2 (TNFR2) had a 60% 12-year cumulative incidence of chronic kidney disease (CKD) Stage 3 or higher, while the 12-year cumulative incidence of end-stage renal disease (ESRD) was 54% for type 2 diabetes patients with the highest concentrations of tumor necrosis factor receptor 1 (TNFR1). “Before, nobody considered that these markers are useful for diagnostic purposes, and now it looks like they are the best,” said lead investigator Andrzej S. Krolewski, MD, PhD, Head of the Section on Genetics and Epidemiology at the Joslin Diabetes Center and Associate Professor of Medicine at Harvard Medical School. “You can just measure their levels and predict what will happen within six to 12 years in the future. None of the other markers is able to do this.” While previous studies showed that the risk of developing diabetes is linked to levels of proinfl ammatory cytokines, such as TNF , it was not known whether chronic infl ammation also contributes to diabetes-related kidney decline. “We have been on a long quest for In Diabetes, TNF Receptors Indicate Risk for Renal Decline