Acylcarnitines and prediction of renal function decline in type 2 diabetes
Authors' conclusion
In patients with type 2 diabetes, four short, three medium and four long-chain acylcarnitines are associated with the rate of kidney function decline. Adding the acylcarnitine score to clinical prediction models improves the identification of individuals who are at greater risk of progression to kidney failure.
Study context
- Population
- Patients with T2D; Aggregate Gargano Mortality Study (aGMS): 9 years median follow-up, mean age 60.9±9.8, mean diabetes duration 11.6±9.3; Joslin Kidney Study (JKS): 10 years median follow-up, mean age 57.8±5.6, mean diabetes duration 14.2±7.62 cohorts
- Participants
- 575 vs 252
- Exposure
- aGMS vs JKS
- aGMSn = 575
- JKSn = 252
- Outcome
- eGFR change over time (mL/min/1.73 m²/year)
Methodological detailsdiscovery and independent validation cohorts, internal validation, Bonferroni correction, multivariable LASSO regression
- Discovery and independent validation cohorts
- Internal validation
- Bonferroni correction
- Multivariable LASSO regression
Main finding
As reported in the abstract
- Acylcarnitines significantly associated with rate of estimated GFR (eGFR) decline after Bonferroni correction (aGMS)
- 11 of 40
- All 11 internally validated
- p<0.05
- Most associations survived adjustment for age, sex, smoking, BMI, HbA1c, disease duration, albumin excretion rate, TG, LDL and statins
- p<0.05
- Tiglylcarnitine and methylglutarylcarnitine, but not tetradecenoylcarnitine and hexadecenoylcarnitine, also associated with eGFR decline in JKS
- p<0.05
Observational data: associations, not effects.
Further findings
Multivariable LASSO regression
- Pairwise correlation among these
- −0.02 to 0.55
- Methylglutarylcarnitine, hydroxyvalerylcarnitine, hexenoylcarnitine, decadienylcarnitine, dodecanedioylcarnitine, tetradecadienylcarnitine independently associated with kidney function decline
Six-molecule acylcarnitine score added to two clinical prediction models of glomerular filtration rate (GFR) decline
- Improved discrimination
- P < 0.01
- Improved reclassification
- P < 0.001
Original publication
Acylcarnitines and prediction of renal function decline in type 2 diabetes. BMJ Open Diabetes Res Care. Published 6 May 2026. doi:10.
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