Nonalbumin proteinuria is a simple and practical predictor of the progression of early-stage type 2 diabetic nephropathy

Aims: Multiple biomarkers have emerged as a reliable predictor of the progression of diabetic nephropathy. The aim of this study was to pursue a more simple and practical predictor that can be applied in clinical practice. Methods: The urine albumin-to-creatinine ratio (ACR), the nonalbumin protein-to-creatinine ratio (NAPCR), and the levels of six biomarkers were measured in 73 patients with type 2 diabetes and estimated glomerular filtration rates (eGFR5) >= 60 mL/min/1.73 m(2). The renal outcomes were the annual decline in eGFR and the development of chronic kidney disease (CKD) of stage 3 or greater. Results: The average rate of eGFR decline over a median of 50 months of follow-up was 2.48 mL/min/ 1.73 m(2)/year. After adjusting for nine clinical parameters, only the NAPCR showed a significant association with the annual eGFR decline (adjusted R-2 = 0.139, P = 0.042). The NAPCR predicted a higher probability of the development of CKD of stage 3 or greater and was more effective than any of the six urinary biomarkers in this respect (C-index 82.7, sensitivity 92.3, specificity 81.7). Conclusions: The NAPCR is a better and more practical predictor of the development and progression of CKD than are other urinary biomarkers in patients with early-stage type 2 diabetic nephropathy. (C) 2016 Elsevier Inc. All rights reserved.