Comparison of Symmetric Dimethylarginine (SDMA), Creatinine, and Cystatin C Level as Biomarkers of Chronic Kidney Disease in Diabetic Patients With and Without Microalbuminuria

Amir Asad  Shah; Maryam  Haroon; Shahnawaz Hassan  Gardezi; Hiba  Zahid; Mian Adnan Aslam  Javaid

doi:10.54112/bcsrj.v6i7.1918

Authors

Amir Asad Shah Department of Pathology, Nishtar Medical University and Hospital, Multan, Pakistan
Maryam Haroon Department of Rheumatology, National Hospital Centre, Lahore, Pakistan
Shahnawaz Hassan Gardezi Department of Medicine, Nishtar Medical University and Hospital, Multan, Pakistan
Hiba Zahid CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
Mian Adnan Aslam Javaid Statistical Analyst. BZU Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i7.1918

Keywords:

Symmetric dimethylarginine, creatinine, cystatin C, chronic kidney disease, diabetic patients, microalbuminuria

Abstract

Diabetic kidney disease remains a major contributor to chronic kidney disease (CKD) morbidity. Earlier detection beyond serum creatinine alone is needed. Symmetric dimethylarginine (SDMA) and cystatin C have been proposed as sensitive markers of reduced glomerular filtration. Objective: To measure and compare the levels of symmetric dimethylarginine, creatinine and Cystatin C in diabetic patients with and without microalbuminuria as markers for diagnosis of chronic kidney disease Methods: This was a case-control study involving 110 diabetic patients with or without microalbuminuria who visited the Departments of Pathology at Nishtar Hospital, Multan Patients were divided into cases (diabetic patients with microalbuminuria) and controls (diabetic patients without microalbuminuria).5 mL blood sample was collected for random blood glucose level, HbA1C, renal function tests (urea & creatinine), SDMA and cystatin C. Results: Among cases (with microalbuminuria), the mean HbA1C (%), SDMA (µmol/L), serum creatinine (mg/dL), serum cystatin C (mg/L) and eGFR (ml/min/1.73m2) was 8.3± 2.1, 1.4 ±0.8, 0.9 ± 1.0, 0.02 ± 0.02 and 94.6 ± 41.2, receptively. Among controls (without microalbuminuria), the mean HbA1C (%), SDMA (µmol/L), serum creatinine (mg/dL), serum cystatin C (mg/L), and eGFR (ml/min/1.73m2) were 7.1 ± 2.4, 1.1 ± 0.9, 0.7 ± 0.4, 0.007± 0.005, and 108.0 ± 53.5, respectively. Conclusion: There were higher levels of SDMA, serum creatinine, and Cystatin C among diabetic patients with microalbuminuria than among patients without microalbuminuria.

Downloads

Download data is not yet available.

References

Nazzal Z, Hamdan Z, Masri D, Abu-Kaf O, et al. Prevalence and risk factors of chronic kidney disease among Palestinian type 2 diabetic patients: a cross-sectional study. BMC Nephrol. 2020;21(1):484. https://doi.org/10.1186/s12882-020-02138-4

Sun H, Saeedi P, Karuranga S, Pinkepank M, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119

Pelle MC, Provenzano M, Busutti M, Porcu CV, et al. Up-date on diabetic nephropathy. Life (Basel). 2022;12(8):1202. https://doi.org/10.3390/life12081202

Ammirati AL. Chronic kidney disease. Rev Assoc Med Bras (1992). 2020;66(Suppl 1):s03–s09. https://doi.org/10.1590/1806-9282.66.S1.3

Gremese E, Bruno D, Varriano V, Perniola S, et al. Serum albumin levels: a biomarker to be repurposed in different disease settings in clinical practice. J Clin Med. 2023;12(18):6017. https://doi.org/10.3390/jcm12186017

Farrington DK, Surapaneni A, Matsushita K, Seegmiller JC, et al. Discrepancies between cystatin C–based and creatinine-based eGFR. Clin J Am Soc Nephrol. 2023;18(9):1143–52. https://doi.org/10.2215/CJN.0000000000000217

Sapkota S, Khatiwada S, Shrestha S, Baral N, et al. Diagnostic accuracy of serum cystatin C for early recognition of nephropathy in type 2 diabetes mellitus. Int J Nephrol. 2021;2021:8884126. https://doi.org/10.1155/2021/8884126

Abdelwahid HA, Dahlan HM, Mojemamy GM, Darraj GH. Predictors of microalbuminuria and its relationship with glycemic control among type 2 diabetic patients of Jazan Armed Forces Hospital, southwestern Saudi Arabia. BMC Endocr Disord. 2022;22(1):307. https://doi.org/10.1186/s12902-022-01232-y

Amelia R, Sari DK, Muzasti RA, Wijaya H. Correlation of cystatin-C with albumin-creatinine ratio for the diagnosis of diabetic nephropathy in patients with type 2 diabetes: a cross-sectional study in Medan, Indonesia. Open Access Maced J Med Sci. 2022;10(T7):12–15. https://doi.org/10.3889/oamjms.2022.9249

Colombo M, McGurnaghan SJ, Blackbourn LA, Dalton RN, et al. Comparison of serum and urinary biomarker panels with albumin/creatinine ratio in the prediction of renal function decline in type 1 diabetes. Diabetologia. 2020;63(4):788–98. https://doi.org/10.1007/s00125-019-05081-8

Li Y, Ji X, Ni W, Luo Y, et al. Serum albumin and albuminuria predict the progression of chronic kidney disease in patients with newly diagnosed type 2 diabetes: a retrospective study. PeerJ. 2021;9:e11735. https://doi.org/10.7717/peerj.11735

Pasternak M, Liu P, Quinn R, Elliott M, et al. Association of albuminuria and regression of chronic kidney disease in adults with newly diagnosed moderate to severe chronic kidney disease. JAMA Netw Open. 2022;5(8):e2225821. https://doi.org/10.1001/jamanetworkopen.2022.25821

Asghar S, Asghar S, Mahmood T, Bukhari SMH, et al. Microalbuminuria as the tip of iceberg in type 2 diabetes mellitus: prevalence, risk factors, and associated diabetic complications. Cureus. 2023;15(8):e43190. https://doi.org/10.7759/cureus.43190

Poulsen CG, Rasmussen DG, Genovese F, Hansen TW, et al. Marker for kidney fibrosis is associated with inflammation and deterioration of kidney function in people with type 2 diabetes and microalbuminuria. PLoS One. 2023;18(3):e0283296. https://doi.org/10.1371/journal.pone.0283296

Penno G, Orsi E, Solini A, Bonora E, et al. Renal hyperfiltration is independently associated with increased all-cause mortality in individuals with type 2 diabetes: a prospective cohort study. BMJ Open Diabetes Res Care. 2020;8(1):e001481. https://doi.org/10.1136/bmjdrc-2020-001481

Peralta CA, Katz R, Sarnak MJ, Ix J, et al. Cystatin C identifies chronic kidney disease patients at higher risk for complications. J Am Soc Nephrol. 2011;22(1):147–55. https://doi.org/10.1681/ASN.2010050483

Liao X, Zhu Y, Xue C. Diagnostic value of serum cystatin C for diabetic nephropathy: a meta-analysis. BMC Endocr Disord. 2022;22(1):149. https://doi.org/10.1186/s12902-022-01052-0

Stankute I, Radzeviciene L, Monstaviciene A, Dobrovolskiene R, et al. Serum cystatin C as a biomarker for early diabetic kidney disease and dyslipidemia in young type 1 diabetes patients. Medicina (Kaunas). 2022;58(2):218. https://doi.org/10.3390/medicina58020218

Levey AS, Gansevoort RT, Coresh J, Inker LA, et al. Change in albuminuria and GFR as end points for clinical trials in early stages of CKD: a scientific workshop sponsored by the National Kidney Foundation in collaboration with the US Food and Drug Administration and European Medicines Agency. Am J Kidney Dis. 2020;75(1):84–104. https://doi.org/10.1053/j.ajkd.2019.06.009

Sukkar L, Kang A, Hockham C, Young T, et al. Incidence and associations of chronic kidney disease in community participants with diabetes: a 5-year prospective analysis of the EXTEND45 study. Diabetes Care. 2020;43(5):982–90. https://doi.org/10.2337/dc19-1803