Association between urinary C-megalin levels and progressive kidney dysfunction: a cohort study based on the diabetes distress and care registry at Tenri (DDCRT 24)

• Published in: Acta diabetologica Vol. 60; no. 12; pp. 1643 - 1650
• Main Authors: Niihata, Kakuya, Nishiwaki, Hiroki, Kinoshita, Maki, Kurosawa, Kentaro, Sakuramachi, Yui, Matsunaga, Satoshi, Okamura, Shintaro, Tsujii, Satoru, Hayashino, Yasuaki, Kurita, Noriaki
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01-12-2023; Springer Nature B.V
• Subjects: Blood pressure; Cohort analysis; Creatinine; Diabetes; Diabetes mellitus; Diabetic Nephropathy; Epidermal growth factor receptors; Hemoglobin; Internal Medicine; Kidney diseases; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Kidney dysfunction; Diabetes; Megalin; Urinary albumin-creatinine ratio
• ISSN: 1432-5233; 0940-5429; 1432-5233
• DOI: 10.1007/s00592-023-02144-6

Aims
The aim of this cohort study was to evaluate the association between urinary levels of C-megalin, a full-length form of megalin, and kidney dysfunction progression and its dependence on the urinary albumin-creatinine ratio (UACR) in individuals with diabetes.
Methods
We enrolled 1,547 individuals with diabetes who visited the ambulatory clinic at Tenri Hospital, a regional tertiary-care hospital in Tenri City, Nara Prefecture, Japan, with an estimated glomerular filtration (eGFR) of ≥ 30 mL/min/1.73 m
2
. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazard models to examine the association between urinary C-megalin levels and eGFR decline by ≥ 40% from baseline.
Results
Urinary C-megalin level was not associated with ≥ 40% eGFR decline in an age-, sex-, eGFR-, systolic blood pressure-, hemoglobin-, and UACR-adjusted model in the 1,547 patients enrolled in the study. However, urinary C-megalin levels were associated with a ≥ 40% decline in eGFR when accounting for the relationship between urinary C-megalin levels and UACR in the model. This association was UACR-dependent.
Conclusions
High urinary C-megalin levels were associated with progressive kidney dysfunction in individuals with diabetes, and this association was attenuated by high UACRs.