Predictive value of serum GDF15 and Nrf2 levels for the prognosis of patients with type 2 diabetic kidney disease
GONG Zhuang
ZHANG Shuhua
XIA Qun
SUN Yidan
Abstract：Objective To investigate the predictive value of serum growth differentiation factor-15(GDF15)and nuclear factor E2-related factor(Nrf2)levels in patients with type 2 diabetic kidney disease(DKD)on the prognosis of patients.Methods A total of 122 patients with DKD were selected from January 2021 to March 2023.All patients were given standardized treatment according to the relevant guidelines and individualized treatment according to the actual condition of the patients.After 2 years of follow-up,they were divided into good prognosis group and poor prognosis group according to the prognosis.The clinical data,serum GDF15 and Nrf2 levels at admission were compared between the two groups.Multivariate logistic regression was used to analyze the prognostic factors of DKD patients,and the interaction index(γ)was used to analyze the interaction between serum GDF15 and Nrf2 in the prognosis of DKD patients.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum GDF15 and Nrf2 on the prognosis of DKD patients.The calibration curve and decision curve analysis(DCA)were used to evaluate the accuracy and clinical utility of the combined prediction model of serum GDF15 and Nrf2.Results They were followed up for 2 years,and 2 patients were lost to follow-up.There were 83 patients in the good prognosis group and 37 patients in the poor prognosis group.The level of serum GDF15 in the poor prognosis group was higher than that in the good prognosis group,while the level of Nrf2 was lower than that in the good prognosis group(P＜0.01).Multivariate logistic regression analysis showed that serum GDF15 and Nrf2 were independent factors affecting the prognosis of DKD patients before and after adjusting other factors(P＜0.01).The OR value of poor prognosis risk in DKD patients with high expression of serum GDF15 and low expression of Nrf2 was 9.473,γ=1.333,showing a positive interaction(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of serum GDF15 and Nrf2 in predicting the prognosis of DKD patients was 0.766 and 0.777 respectively,with the Youden index of 0.441 and 0.437,the sensitivity of 62.16％and 81.08％,and the specificity of 81.93％and 62.65％,respectively.The AUC of serum GDF15 and Nrf2 combined prediction model in predicting the prognosis of DKD patients was 0.890,with the Youden index of 0.639,the sensitivity of 78.38％,and the specificity of 85.54％,showing significantly increased predictive value(P＜0.05).The calibration curve showed that the observed value and the predicted value of the combined prediction model of serum GDF15 and Nrf2 had a high coincidence degree,and the correlation Dxy value between the predicted value and the actual value was 0.851,and the prediction accuracy was high.The DC A curve showed that when the threshold probability interval was 10％-100％,the combined prediction model of serum GDF15 and Nrf2 had a higher net benefit in predicting the prognosis of DKD patients Conclusion The high expression of serum GDF15 and low expression ofNrf2 in DKD patients have a positive interaction in the risk of poor prognosis of DKD,which can effectively predict the prognosis of DKD,and the combined prediction of the two has high accuracy and clinical utility.
Keywords：type 2 diabetic kidney diseasegrowth differentiation factor-15nuclear factor E2-related factorprognosisinteractionreceiver operating characteristic curve
Publication Date：2025-12-28
Online Publishing Date：2026-01-16(First online date of this platform, not the publication date of the document)
Pages：7( 69-75 )