Role of novel biomarkers urinary NGAL and MCP-1 in predicting progression of diabetic kidney disease in type 2 DM

The prediction of rapid progression in diabetic kidney disease (DKD) remains a global challenge. This study evaluated the prognostic value of two noninvasive biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein-1 (MCP-1) in identifying rapid DKD progression. In this prospective observational study, 145 T2DM patients with DKD (October 2021–June 2024) were categorized as rapid or nonrapid progressors based on an eGFR decline >5 mL/1.73 m²/year. Baseline urinary(u) NGAL and MCP-1 were measured by ELISA. Clinical profiles, risk factors, and predictive utility of the biomarkers were analyzed. During a median follow-up of 1.3 years, 38.6% were rapid progressors. Hypertension, cardiovascular disease, elevated SBP, high fasting blood sugar, and higher urinary albumin-to-creatinine ratio (uACR) were significantly associated with rapid progression (p < 0.05). Median uNGAL and uMCP-1 levels were higher in rapid progressors (57.6 vs 28.2 ng/ml; 469 vs 220 pg/ml; p = 0.01) and increased with albuminuria severity (p = 0.03 and p = 0.01). Multivariate analysis identified uNGAL, uMCP-1, and uACR as independent risk factors. uMCP-1 showed the highest diagnostic accuracy (AUC 0.94; 94.1% sensitivity; 89.2% specificity at 381.2 pg/ml). uNGAL had an AUC of 0.86 (83.4% sensitivity; 77.3% specificity at 39.8 ng/ml). A combined panel of uMCP-1, uNGAL, and uACR further improved predictability (AUC 0.96). Patients with elevated uNGAL and uMCP-1 levels experienced a greater incidence of rapid progression similar to uACR. uMCP-1 exhibited better diagnostic accuracy than did uNGAL and uACR, with better sensitivity and specificity in identifying rapid progressors. The combination of three noninvasive biomarkers had further improved predictability.