Abstract
AIMS/HYPOTHESIS: Potentially modifiable biomarkers may influence the decline in estimated GFR (eGFR), but few data are currently available in type 2 diabetic adults. METHODS: We studied 516 women with type 2 diabetes in the Nurses' Health Study with data on lipid and inflammatory biomarkers from plasma collected in 1989 and plasma creatinine in samples collected in 1989 and 2000. An estimated GFR decline of >or=25% over 11 years was the outcome of interest. RESULTS: Comparing the highest with the lowest quartile, soluble tumour necrosis factor receptor 2 (sTNFR-2) was independently associated with an eGFR decline of >or=25% (multivariate OR 5.81; 95% CI 2.90-11.65); this association was stronger in obese women (OR 16.76; 95% CI 4.69-59.90 for BMI >or=30 kg/m(2); OR 2.78, 95% CI 1.12-6.89 for BMI <30 kg/m(2); p for interaction = 0.02). No lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, non-HDL-cholesterol, triacylglycerols, lipoprotein(a), or apolipoprotein B) or other markers of inflammation (C-reactive protein, fibrinogen, E-selectin, intracellular cell adhesion molecule 1, leptin or adiponectin) were significantly associated with eGFR decline after multivariable adjustment. CONCLUSIONS/INTERPRETATION: Elevated sTNFR-2 levels may be an important and potentially modifiable risk factor for eGFR decline in type 2 diabetes, especially in those with a BMI of >or=30 kg/m(2).