Urinary N-Acetyl-β-D-Glucosaminidase May Identify Faster Progression in Diabetic Patients With Late-Stage Chronic Kidney Disease

Yuan-Chuan Kuo ； Win-Lin Yeh ； Tsai-Kun Wu ； Kung-Chi Chan

《Acta Nephrologica》 32卷1期 (2018/03) Pp. 3-11

https://doi.org/10.6221/AN.201803_32(1).0002

摘要

BACKGROUND: The rate of chronic kidney disease (CKD) progression is highly variable between individuals. Sustained kidney injury is associated with CKD progression. We are interested in whether urinary N-acetyl-β-D-glucosaminidase (NAG) could predict the progression of renal function in late-stage of diabetic CKD. METHODS: In this study, we enrolled 30 diabetic patients with stage 3-4 CKD and measured their urinary NAG concentrations initially. During a median 26-month follow-up of these subjects, we analyze the annual change and the percentage reduction in the estimated glomerular filtration rate (eGFR) separately by the urinary NAG at cut-off point of 15 ng/mL. Two-way analysis of variance (ANOVA) with Bonferroni correction post hoc tests was applied to estimate differences between groups. RESULTS: Based on annual change of eGFR analysis, there are significant differences between the separated NAG groups in patients with stage 3A and 3B CKD (P = 0.004 and P = 0.003, respectively), however there is no significant difference in patients with stage 4 CKD (P = 0.014). Nevertheless, there are significant differences between the separated NAG groups in all stratified patients with CKD staging (P = 0.005 in stage 3A, P = 0.001 in stage 3B and P = 0.004 in stage 4, respectively) based on the percentage reduction of eGFR analysis. CONCLUSION: We conclude that higher level of urinary NAG has greater risk for faster loss of renal function in diabetic patients with late-stage CKD. Urinary NAG is a useful biomarker for detection of ongoing kidney injury and may help identify patients with faster GFR decline in clinical practice.

關鍵字

eGFR ； faster progression ； kidney injury ； late-stage diabetic CKD ； urinary NAG