Urine clusterin/apolipoprotein J is linked to tubular damage and renal outcomes in patients with type 2 diabetes mellitus

Summary

Objective

The objective of this study was to evaluate the association of urine clusterin/apolipoprotein J (Apo J) with the development and/or progression of diabetic kidney disease (DKD) in type 2 diabetes.

Materials and methods

159 type 2 diabetic patients and 20 non-diabetic subjects with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² were enrolled. The baseline values of urine clusterin and tubular damage markers were measured. The primary outcome was the annual decline rate in eGFR and secondary outcomes were the development of chronic kidney disease (CKD) stage 3 or greater and the persistence/progression of albuminuria. The median follow-up duration of enrolled patients was 3.0 (1.0–5.9) years.

Results

Baseline clusterin levels in urine were significantly increased in type 2 diabetic subjects compared with those of non-diabetic subjects. The levels of urine clusterin had a significant correlation with urine tubular damage markers. A positive correlation between the annual rate of decline in eGFR and urine clusterin after adjusting for clinical confounding factors was detected. Multivariate analysis further indicated that urine clusterin correlated with the development of CKD stage 3 or greater and persistence/progression of albuminuria. In type 2 diabetic subjects with albuminuria, urine clusterin remained associated with the annual decline rate in eGFR and the progression of CKD stage.

Conclusions

Urine clusterin reflects tubular damage in the early-stage of DKD. The increase of urine clusterin along with albuminuria could be an independent predictive marker for the progression of DKD in type 2 diabetes.

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