Blood biomarker tests play a key role in assessing cardiovascular and renal risks in diabetic patients, but a recent AHA study out of Harvard Medical School suggests that a “simple” new multimarker test could significantly improve these assessments and downstream treatment decisions.
Using plasma samples from 2,627 CREDENCE trial participants with type 2 diabetes and kidney disease, the researchers first measured median baseline levels of four blood-based biomarkers:
- NT-proBNP: 180 ng/L
- high-sensitivity cardiac troponin T: 19 ng/L
- growth differentiation factor-15: 2595 ng/L
- IGFBP7: 121.8 ng/mL
The participants’ individual biomarker levels proved to be “strongly predictive of cardiac and renal outcomes,” with 50% increases to any biomarker over one year significantly increasing their risk of experiencing the study’s primary endpoint (a composite of end-stage kidney disease, doubling serum creatinine level, renal death, or cardiovascular death):
- NT-proBNP: Hazard ratio 1.11
- hs-TnT: Hazard ratio 1.86
- GDF-15: Hazard ratio 1.45
- IGFBP7: Hazard ratio 3.76
When these four biomarkers were combined into a multimarker panel, participants with moderate and high multimarker scores had far greater risks of experiencing a primary outcome compared to participants with low scores (Hazard ratios: 2.39 & 4.01, both P < .001).
They also found that the sodium-glucose cotransporter-2 inhibitor canagliflozin slowed increases to biomarker levels.
- Canagliflozin group: 3% to 10% biomarker increases
- Placebo group: 6% to 29% biomarker increases
Canagliflozin’s biomarker improvements are promising, but the study authors were most excited about how the adoption of a simple blood-based multimarker test could improve care and outcomes for diabetic patients with CKD – especially if these combined biomarkers evolved into a single standardized risk score.
- That might come sooner than some expect, noting that three of these individual biomarkers are available clinically (IGFBP7 is on the way), although more research will be needed to assign weights to each biomarker.
Biomarker testing already has a solid foundation in cardiology and diabetes care, but a simple and effective multimarker test like this could drive even greater advances in clinical adoption, accuracy, and personalized treatments.