Omics research in diabetic kidney disease: new biomarker dimensions and new understandings?
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REVIEW
Omics research in diabetic kidney disease: new biomarker dimensions and new understandings? Nete Tofte1 · Frederik Persson1 · Peter Rossing1,2 Received: 5 March 2020 / Accepted: 23 May 2020 © Italian Society of Nephrology 2020
Abstract The use of “omics” is increasing in research areas looking to identify biomarkers or early preclinical signs of disease or to increase understanding of complex pathological processes that determines prognosis of the disease. Diabetic kidney disease is no exception as it is an area in need of further improvement of both understanding and prognosis. In addition, there is a notion that pretreatment investigations using techniques like proteomics, lipidomics and metabolomics can help individualize therapy thus fulfilling the wish for personalized medicine. An increasing number of cohort studies using these techniques are published, but only few have been validated in external cohorts or even replicated by other groups. In essence, to achieve clinical impact and usefulness, prospective validation is needed. So far, only the urinary proteomics based PRIORITY study has tried to do this, as discussed in this review. Other areas are promising, but are currently lacking such efforts. In this review we report and discuss the current status of urinary proteomics as well as plasma metabolomics and lipidomics with an overview of the results so far, and with some comments and perspectives regarding future developments and implementation. As is evident, these techniques are promising, but there is still some way before widespread clinical use can be foreseen. Keywords Diabetes · Diabetic kidney disease · Biomarkers · Omics · Proteomics · Metabolomics
Introduction The prevalence of type 2 diabetes is increasing globally [1]. People with diabetes have a high risk of late complications related to both the micro- and macrovascular circulation [2]. One of the major microvascular complications to diabetes is diabetic kidney disease (DKD) [3] and it is estimated that approximately 40% of all individuals with diabetes will develop DKD. DKD is the leading cause of end stage kidney disease (ESKD) in the developed world and accounts for approximately 50% of all cases of ESKD [4]. The only treatment options for ESKD are dialysis or kidney transplantation. DKD is also associated with a substantially higher risk of cardiovascular disease and mortality [5–7]. This leads to a substantial disease burden for the person with diabetes [8]. In addition, this remains an economic burden for the
* Peter Rossing [email protected] 1
Steno Diabetes Center Copenhagen, Gentofte, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
2
health care systems [9, 10]. Current treatment is not able to prevent this but can only delay this to a small degree. Thus, there is an unmet need for better treatment, ideally starting as early as possible to prevent initiation or delay progression, in the fraction of individuals at risk. The classic markers of renal function have impr
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