Predictive value of ferroptosis-related biomarkers for diabetic kidney disease: A prospective observational study

Objective: To explore the predictive value of ferroptosis-related (FR) biomarkers for diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods This prospective observational study enrolled patients with T2DM at the Second Hospital of Jilin University between December 2021 and March 2022. DKD was measured by the urinary albumin to creatinine ratio (UACR). Receiver operator characteristic curve (ROC) analysis were performed to assess the predictive value of ferroptosis-related biomarkers for DKD. Results Finally, 118 patients (53.0 ± 12.2 years, 76 males) were enrolled, 52 of them without DKD (had normal proteinuria), while 66 with DKD (41 had microproteinuria, and 25 had massive proteinuria). FR biomarkers, including acyl-coa synthase long chain family member 4 (ACSL4), malondialdehyde (MDA), and reactive oxygen species (ROS) were significantly higher in the massive proteinuria group than in the other groups, while glutathione peroxidase 4 (GPX4) was significantly lower (all P < 0.05). The area under the ROC of the combination of GPX4, ACSL4, MDA, and ROS for predicting DKD was 0.804 (P < 0.001). Additionally, multivariate logistic regression analysis showed that the course of disease and ferritin levels were independent risk factors for massive proteinuria, while high serum iron, transferrin, and GPX4 levels were independent protective factors for massive proteinuria in patients with T2DM (all P < 0.05). Conclusion The GPX4, ACSL4, MDA, and ROS combination might have a good predictive value for DKD. Additionally, the course of disease, ferritin levels, serum iron, transferrin, GPX4 were independently associated with massive proteinuria.