Information for Clinicians
The iMODE-CKD project aims to elucidate the mechanisms of CKD progression and to identify relevant biomarkers and therapeutic targets
Current state-of-the-art in the management of CKD:
• Detection of microalbuminuria (range: 30–300 mg/L) currently remains the optimal predictor of CKD progression in diabetic patients. However, intra-individual variability markedly compromises the accuracy of this method in detecting CKD progression.
• Reduction in glomerular filtration rate (GFR) is a useful marker only at late disease stages,.
Thus, it is imperative to identify diagnostic biomarkers for early stage CKD, as well as prognostic markers for disease progression. The current project will investigate and validate a range of non-invasive -omics biomarkers for predicting CKD progression and outcome.
Aim of the project: To discriminate between rapid and delayed CKD progression
Potential prognostic biomarkers for CKD progression will be evaluated in a cohort of CKD patients. The investigated biomarkers will be associated with:
• accumulation in the systemic circulation of substances normally cleared by the kidneys, as well as markers of glomerular vascular damage;
• urinary excretion of markers of glomerular and/or tubular damage,
• urinary excretion of mediators of renal scarring;
• urinary excretion of extracellular matrix (ECM) components and/or fibrosis mediators, including regulatory enzymes, which accumulate in fibrotic kidneys.
Study population: Patient Cohort
1. The study cohort to be recruited includes CKD patients, of varying disease stages, with proteinuria >0.5 g/L.
- Routine haematology and biochemical measurements will be conducted at baseline (first renal biopsy), as well as annually for a total of 3 years (second renal biopsy). Biomarkers (including serum creatinine, serum albumin, phosphorus, glucose, and urea) will also be measured at baseline and annually.
2. CKD progression will be monitored based on:
- GFR will be calculated by various equations including: Cocroft – Gault, extended MDRD, abbreviated MDRD equation, and CKD-EPI. An eGFR decline >3ml/min/year will be applied as the criterion for CKD progression. Renal biopsy will be repeated at years 0 and 3 in patients with clinical and/or laboratory indications of disease progression. Findings will be used to evaluate histological lesions, including renal fibrosis.