Growth differentiation factor 15 as a predictor of adverse renal outcomes in patients with immunoglobulin A nephropathy.

BACKGROUND: Growth differentiation factor 15 (GDF 15) has recently been reported as a useful prognostic marker in patients with chronic inflammatory disease and heart disease. AIM: To evaluate the role of GDF 15 as a potential prognostic predictor of renal outcome in immunoglobulin A nephropathy (IgAN). METHODS: In total, 212 patients in the Chungnam National Hospital glomerulonephritis cohort, who were diagnosed as biopsy-proven IgAN between March 2010 and June 2014, were included. GDF Fifteen was analysed by the enzyme-linked immunosorbent assay. Cut-off values of the GDF 15 and the hazard ratio of it resulting in haemodialysis within 2 years were analysed. RESULTS: The level of serum GDF 15 was negatively correlated with the initial eGFR. A serum GDF 15 level of more than 496.32 pg/mL showed 90% sensitivity and 72.9% specificity to predict the possibility of it resulting in haemodialysis within 2 years. In addition, a GDF 15 level higher than 490.4 pg/mL showed 63.64% sensitivity and 65% specificity to predict a decline in eGFR > 30 mL/min within 1 year of follow up. Moreover, initial serum GDF 15 level was associated with the development of interstitial fibrosis/tubular atrophy. CONCLUSIONS: Initial serum GDF 15 level showed an inverse correlation with serum eGFR and was associated with worse renal outcome. Our results suggested that GDF 15 may play a role as a potential prognosticator in IgAN.

Efficacy, safety and albuminuria-reducing effect of gemigliptin in Korean type 2 diabetes patients with moderate to severe renal impairment: A 12-week, double-blind randomized study (the GUARD Study).

AIMS: This multicentre, randomized, double-blind study investigated the efficacy and safety of gemigliptin in Korean type 2 diabetes mellitus (T2DM) patients with moderate to severe renal impairment (RI). METHODS: The study comprised a 12-week main part and a 40-week extension. We report here the results from the main part. In total, 132 patients were randomized to receive gemigliptin (n = 66) or placebo (n = 66). Changes in glycated haemoglobin (HbA1c; primary endpoint), other glycaemic control parameters (fasting plasma glucose, glycated albumin and fructosamine), lipid profiles, renal function parameters and safety profiles were evaluated. RESULTS: Baseline characteristics were comparable between the groups (mean HbA1c, 8.4% [68 mmol/mol]; age, 62.0 years; duration of type 2 diabetes, 16.3 years; estimated glomerular filtration rate, 33.3 mL/min/1.73 m2 ). At Week 12, the adjusted mean change ± standard error in HbA1c with gemigliptin was -0.82% ± 0.14% (-8.9 ± 1.5 mmol/mol), whereas it was 0.38% ± 0.14% (4.2 ± 1.5 mmol/mol) with placebo (significant between-group difference, P < .001). Other glycaemic control parameters showed beneficial changes as well. Body weight change (gemigliptin, -0.3 kg; placebo, -0.2 kg) was not significant. In the gemigliptin group, the mean decrease in urinary albumin creatinine ratio (UACR) was significant, both in patients with microalbuminuria (-41.9 mg/g creatinine, P = .03) and macroalbuminuria (-528.9 mg/g creatinine, P < .001). Drug-related adverse events were similar with gemigliptin and placebo (15% and 12%, respectively). CONCLUSIONS: A 12-week treatment with gemigliptin improved glycaemic control and provided UACR reduction in T2DM patients with moderate to severe RI. Gemigliptin was well tolerated, with no additional risk of hypoglycaemia and change in body weight.