Published in:
01-10-2013 | Nephrology - Original Paper
Low serum endothelial cell-selective adhesion molecule predicts increase in albuminuria in type 2 diabetes patients
Published in: International Urology and Nephrology | Issue 5/2013
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Purpose
The newly discovered endothelial cell-selective adhesion molecule (ESAM) stabilizes the interendothelial tight junction; it circulates in serum as a soluble fraction. In experimental diabetes, reduced ESAM expression in the kidney is associated with albuminuria. We investigated, for the first time, serum ESAM as a predictor of progression of kidney disease in type 2 diabetes (T2D).
Methods
T2D non-nephrotic patients with glomerular filtration rate (GFR) > 30 ml/min were included. History, medication and laboratory evaluation were assessed at inclusion and the end of study; ESAM was determined at baseline.
Results
Eighty-eight patients—mean age 63 ± 10.84 years, 49 (55.68 %) males—were prospectively followed up for 20 months. Baseline GFR was 76.37 ± 29.56 ml/min, and urinary albumin/creatinine ratio (UACR) 21.63(7.08–94.52) mg/g; ESAM was 12.85(6.13–19.83) ng/ml. Difference (Δ) in UACR between end of study and baseline was inversely related to serum albumin (r = −0.27, p = 0.017) and ESAM (r = −0.21, p = 0.047); ΔGFR correlated to glycated hemoglobin (r = 0.22, p = 0.05). In multiple regression, introducing variables susceptible to influence progression of kidney disease, ΔUACR was significantly related to log ESAM (p = 0.005) and ΔGFR to glycated hemoglobin (p = 0.016).
Conclusion
Serum ESAM is a predictor of worsening of albuminuria in T2D patients without advanced kidney disease.