2701-LB: Independent Prognostic Value of the Novel Early Biomarker uPTM-FetA/Ucr in Diabetic Kidney Disease: Overcoming Treatment Confounders in a Real-World Cohort

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Introduction and Objective: Accurate risk stratification in Diabetic Kidney Disease (DKD) is often confounded by nephroprotective medications (e.g., SGLT2i) and the non-linear dynamics of traditional biomarkers in advanced stages. This study evaluated the disease specificity and independent prognostic value of a novel biomarker, uPTM-FetA/Ucr, across the diabetes disease continuum, in a real-world cohort.Methods: A cross-sectional cohort of 460 participants receiving care at Metabolic was analyzed, comprising Normal (n=54), Prediabetes (n=54), Type 1 Diabetes (n=48), and Type 2 Diabetes (n=304) subjects. Baseline uPTM-FetA/Ucr expression was assessed using Kruskal-Wallis and Wilcoxon tests. To predict ordinal KDIGO risk categories (Low, Moderately, High/Very High), a Partial Proportional Odds Model (PPOM) was used to address violations of the proportional odds assumption. Model adjusted for BMI, diabetes status, and nephroprotective medications (SGLT2i, ACEi, GLP1RA).Results: uPTM-FetA/Ucr exhibited exceptional disease specificity, maintaining stable baseline levels in Normal and Prediabetes groups (p-value nonsignificant), with significant elevations exclusively in overt T1DM and T2DM (p < 0.05). In the fully adjusted PPOM, uPTM-FetA/Ucr emerged as an independent predictor of advanced KDIGO stages (Adjusted OR = 1.28, 95% CI: 1.01-1.64, p = 0.044). Unlike traditional markers such as Urea and HbA1c, which varied with disease severity, uPTM-FetA/Ucr fulfilled the proportional odds assumption across all KDIGO stages. Its prognostic power remained robust despite the confounding effects of nephroprotective therapies.Conclusion: In a real-world hybrid care cohort, uPTM-FetA/Ucr is a specific and independent prognostic biomarker for DKD, providing stable risk stratification across KDIGO stages independent of metabolic control and treatment confounders.

Disclosure

H. Zakaria: None. J. Ali: None. S.A. Abdelmagid: None. A. Alkindi: None. R.O. Raflores: None. C. Huang: Employee; Current; Bio Preventive Medicine Corp. T.K. Tseng: Board Member; Current; Bio Preventive Medicine Corp. A. Almarzooqi: None. A. Hashemi: None. I. Almarzooqi: None.



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