Urine Tricarboxylic Acid Cycle Metabolites and Risk of End-stage Kidney Disease in Patients With Type 2 Diabetes
Authors' conclusion
Urine fumarate and citrate predict the risk for progression to end-stage kidney disease independent of clinical risk factors and other urine metabolites. These 2 metabolites in TCA cycle pathway may play important roles in the pathophysiological network, underpinning progressive loss of kidney function in patients with type 2 diabetes.
Study context
- Population
- People with T2D in a regional hospital and a primary care facility
- Participants
- 1,826 vs 1,235
- Exposure
- Urine tricarboxylic acid (TCA) cycle metabolite levels
- Discoveryn = 1,826
- Validationn = 1,235
- Outcome
- CKD progression: composite of sustained eGFR <15 mL/min/1.73 m², dialysis, renal death or doubling of serum creatinine
Methodological detailsdiscovery and validation cohorts
- Discovery and validation cohorts
Main finding
As reported in the abstract
CKD progression (renal outcome), discovery cohort · median 9.2 (IQR 8.1-9.7) years
Adjusted hazard ratio (95% CI)
Urine lactate (per SD)
1.63(1.16–2.28)
Urine fumarate (per SD)
1.82(1.17–2.82)
Urine malate (per SD)
1.49(1.05–2.11)
Urine citrate (per SD)
0.83(0.72–0.96)
Per SD, as printed
Observational data: associations, not effects.
Original publication
Urine Tricarboxylic Acid Cycle Metabolites and Risk of End-stage Kidney Disease in Patients With Type 2 Diabetes. J Clin Endocrinol Metab. Published 28 March 2024. doi:10.
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