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The association between endostatin and kidney disease and mortality in patients with type 2 diabetes
Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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2016 (English)In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: Circulating endostatin, a biologically active derivate of collagen XVIII, is considered to be a marker of kidney disease and a risk factor for its related mortality. However, less is known of the role of endostatin in diabetes and the development of diabetic nephropathy. For this reason, our study investigated the associations between circulating endostatin and the prevalence and progression of kidney disease, and its mortality risk in patients with type 2 diabetes (T2D).

METHODS: This was a cohort study of 607 patients with T2D (mean age: 61 years, 44% women). Estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was used to assess the patients' kidney function decline and mortality.

RESULTS: Of the total study cohort, 20 patients declined by ≥20% in eGFR over 4 years, and 44 died during the follow-up (mean duration: 6.7 years). At baseline, participants with diabetic nephropathy (defined as eGFR<60mL/min/1.73m(2)) and/or microalbuminuria [defined as a urinary albumin-to-creatinine ratio (ACR)>3g/mol] had higher median levels of endostatin than those without nephropathy (62.7μg/L vs 57.4μg/L, respectively; P=0.031). In longitudinal analyses adjusted for age, gender, baseline eGFR and ACR, higher endostatin levels were associated with a higher risk of decline (≥20% in eGFR, OR per 1 SD increase: 1.73, 95% CI: 1.13-2.65) and a higher risk of mortality (HR per 1 SD increase: 1.57, 95% CI: 1.19-2.07).

CONCLUSION: In patients with T2D, circulating endostatin levels can predict the progression of kidney disease and mortality independently of established kidney disease markers. The clinical usefulness of endostatin as a risk marker in such patients merits further studies.

Place, publisher, year, edition, pages
Elsevier, 2016.
Keyword [en]
Albumin-to-creatinine ratio, Angiogenesis, Chronic kidney disease, Community, Extracellular matrix remodeling, NIDDM
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-129960DOI: 10.1016/j.diabet.2016.03.006PubMedID: 27080454OAI: diva2:945686
Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2016-07-05Bibliographically approved

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Östgren, Carl JohanLänne, TosteNyström, Fredrik H
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Division of Community MedicineFaculty of Medicine and Health Sciences"Primary Health Care in Motala"Division of Cardiovascular MedicineDepartment of Thoracic and Vascular SurgeryDepartment of Endocrinology
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Diabetes & Metabolism
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