A Retrospective Analysis Of Hematologic Parameters in Patients With Early Diabetic Kidney Disease Ⅱ

Discussion 

Management of diabetic patients with complications brings huge economic burden to their family and society. Most of the complications, such as diabetic nephropathy is usually progress slowly without obvious clinical manifestations, which may eventually progress to renal failure. Therefore, it is essential to identify novel non-invasive biomarkers that can be used to predict early DKD. In this study, the hematologic parameters from 134 DM cases with normal renal function and 49 cases with early DKD were retrospectively analyzed. The area under ROC curve of PLR in the early DKD group was significantly higher than that of NLR, N and M. The sensitivity (83.7%) and specificity (82.6%) of PLR were also higher than those of N,M groups, which indicated that PLR is a better biomarker for the prediction of early diabetic nephropathy in diabetic patients. As shown in Table 3, the cut-off value of PLR is 68.86 which means when PLR < 68.86, patients are more likely to develop to early DKD. A recent study supported our conclusion that PLR could be used to predict renal function in patients with rapidly progressive glomerulonephritis (RPGN), and they found that PLR was significantly higher in patients with preserved renal function in comparison to patients who required maintenance hemodialysis.12 Another report demonstrated that PLR is a predictor of clinical outcomes in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors.13 It should also be noted that machine learning(ML) methods can further improve the accuracy of the prediction (AUC); as this ML method has been widely used in clinical practice.14

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GFR is the most common prognostic biomarker for predicting ESRD in clinical practice and albuminuria is aslo a traditional diagnosis biomarker that strongly predicts the progression of DKD but it lacks specificity and sensitivity for ESRD.15 In addition to the traditional diagnosis methods for DKD, many potential biomarkers have been investigated. Non-coding RNAs, such as microRNAs (miRNAs) as new diagnostic markers for DKD have attracted extensive attention. Previous studies demonstrated that the level of miR-31 was significantly lower in patients with DKD than that of diabetic patients without complications.16 Another study indicated that the expression levels of miR-27b-3p and miR-1228-3p in the urine were able to discriminate DKD patients from other glomerulonephritis in diabetic patients.17 Collectively, results from these studies pointed out that miRNAs may be used as potential biomarkers for predicting DKD in patients with type 2 DM.

With the continuous development of diagnosis and treatment methods, a more standardized and effective individualized (personalized) diagnosis and treatment regimen for diabetic nephropathy patients will be available, which will improve the prognosis of diabetic patients with nephropathy

However, our current study has a few limitations, one of which is that there were only 183 cases in total, with merely 49 patients with early DKD. Considering the relatively small patient population in this analysis, more clinical cases are needed to confirm our findings in future study and a multivariable regression model can also be used for the prediction purpose. Another limitation is that this is a case-control study the prevalence of the disease in this study cannot reflect its prevalence in the population. In addition, this is a cross-sectional rather than longitudinal design and such design cannot confirm the causal relationship. Lastly, we did not analyze the prognosis of the enrolled cases. In order to address these limitations, another follow-up study is in progress.

Acknowledgment

This study was supported by the Department of Laboratory Medicine, Jingzhou Central Hospital. 

Author Contributions Xu Chen and Qinhua Wang was involved in the paper drafting, responsible for data collection and data analysis; Chengbin Li was in charge of the research design and critical revision of the manuscript. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the project of Jingzhou Science and Technology Plan in 2019, (grant number 2019HC28). ORCID iD Xu Chen https://orcid.org/0000-0001-6905-0979 

References 

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9. Huszno J, Kolosza Z, Mrochem-Kwarciak J, Rutkowski T, Skladowski K. The role of neutrophil-lymphocyte ratio, plateletlymphocyte ratio, and platelets in the prognosis of metastatic renal cell carcinoma. Oncology. 2019;97(1):7-17. 

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