Association of Succinate and Adenosine Nucleotide Metabolic Pathways with Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus

• Published in: Diabetes & metabolism journal Vol. 48; no. 6; pp. 1126 - 1134
• Main Authors: Jung, Inha, Nam, Seungyoon, Lee, Da Young, Park, So Young, Yu, Ji Hee, Seo, Ji A, Lee, Dae Ho, Kim, Nan Hee
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Diabetes Association / Daehan Dangnyobyeong Hakoe 01.11.2024; Korean Diabetes Association; 대한당뇨병학회
• Subjects: 5'-Nucleotidase; Adenosine; Adenosine - metabolism; Aged; Albuminuria; Apyrase - metabolism; Biomarkers; Biomarkers - blood; Case-Control Studies; Creatinine; Dehydrogenases; Diabetes; diabetes mellitus, type 2; Diabetes Mellitus, Type 2 - complications; diabetic nephropathies; Diabetic Nephropathies - blood; Diabetic Nephropathies - metabolism; Enzymes; Female; Glomerular Filtration Rate; GPI-Linked Proteins; Humans; Hyaluronic Acid - blood; Kidney diseases; Male; Medical records; Metabolic Networks and Pathways; Metabolites; MicroRNAs; Middle Aged; Mortality; Original; Regression analysis; Succinic Acid - blood; Succinic Acid - metabolism; Succinic Acid - urine; Urine; Variables; 내과학; United States > US; Biomarkers; Albuminuria; Diabetes mellitus, type 2; Diabetic nephropathies
• ISSN: 2233-6079; 2233-6087; 2233-6087
• DOI: 10.4093/dmj.2023.0377

Background: Although the prevalence of diabetic kidney disease (DKD) is increasing, reliable biomarkers for its early detection are scarce. This study aimed to evaluate the association of adenosine and succinate levels and their related pathways, including hyaluronic acid (HA) synthesis, with DKD.Methods: We examined 235 participants and categorized them into three groups: healthy controls; those with diabetes but without DKD; and those with DKD, which was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We compared the concentrations of urinary adenosine, succinate, and HA and the serum levels of cluster of differentiation 39 (CD39) and CD73, which are involved in adenosine generation, among the groups with DKD or albuminuria. In addition, we performed multiple logistic regression analysis to evaluate the independent association of DKD or albuminuria with the metabolites after adjusting for risk factors. We also showed the association of these metabolites with eGFR measured several years before enrollment. This study was registered with the Clinical Research Information Service (https://cris.nih.go.kr; Registration number: KCT0003573).Results: Urinary succinate and serum CD39 levels were higher in the DKD group than in the control and non-DKD groups. Correlation analysis consistently linked urinary succinate and serum CD39 concentrations with eGFR, albuminuria, and ΔeGFR, which was calculated retrospectively. However, among the various metabolites studied, only urinary succinate was identified as an independent indicator of DKD and albuminuria.Conclusion: Among several potential metabolites, only urinary succinate was independently associated with DKD. These findings hold promise for clinical application in the management of DKD.