The prediction of rapid progression in diabetic kidney disease (DKD) remains a global challenge. This study evaluated the prognostic value of two noninvasive biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein-1 (MCP-1) in identifying rapid DKD progression. In this prospective observational study, 145 T2DM patients with DKD (October 2021–June 2024) were categorized as rapid or nonrapid progressors based on an eGFR decline >5 mL/1.73 m2/year. Baseline urinary(u) NGAL and MCP-1 were measured by ELISA. Clinical profiles, risk factors, and predictive utility of the biomarkers were analyzed. During a median follow-up of 1.3 years, 38.6% were rapid progressors. Hypertension, cardiovascular disease, elevated SBP, high fasting blood sugar, and higher urinary albumin-to-creatinine ratio (uACR) were significantly associated with rapid progression (p < 0.05). Median uNGAL and uMCP-1 levels were higher in rapid progressors (57.6 vs 28.2 ng/ml; 469 vs 220 pg/ml; p = 0.01) and increased with albuminuria severity (p = 0.03 and p = 0.01). Multivariate analysis identified uNGAL, uMCP-1, and uACR as independent risk factors. uMCP-1 showed the highest diagnostic accuracy (AUC 0.94; 94.1% sensitivity; 89.2% specificity at 381.2 pg/ml). uNGAL had an AUC of 0.86 (83.4% sensitivity; 77.3% specificity at 39.8 ng/ml). A combined panel of uMCP-1, uNGAL, and uACR further improved predictability (AUC 0.96). Patients with elevated uNGAL and uMCP-1 levels experienced a greater incidence of rapid progression similar to uACR. uMCP-1 exhibited better diagnostic accuracy than did uNGAL and uACR, with better sensitivity and specificity in identifying rapid progressors. The combination of three noninvasive biomarkers had further improved predictability.
Swaminathan et al. (2025) studied this question.