BACKGROUND

Growth/differentiation factor-15 (GDF-15) plays a crucial role in modulating inflammation and fibrosis and is emerging as a potential biomarker in metabolic diseases. This study investigated the association between circulating GDF-15 levels and the development of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM), with or without metabolic dysfunction-associated fatty liver disease (MAFLD).

METHODS

In this prospective observational study, participants were stratified into three groups: those with T2DM and MAFLD (Group A) and those with T2DM and no MAFLD (Group B), alongside a healthy control group (Group C). Comprehensive clinical evaluations and laboratory assessments, including measurements of GDF-15, metabolic profiles, liver enzymes, and renal function, were performed.

RESULTS

GDF-15 levels demonstrated a stepwise elevation from controls to T2DM patients, with the highest levels observed in patients with MAFLD (1929 ± 412 pg/mL in Group A, 1655 ± 368 pg/mL in Group B, and 1246 ± 245 pg/mL in Group C; p < 0.001). DKD was diagnosed in 51.4 % of patients in Group A compared to 37.1 % in Group B (p < 0.001). Multivariate analysis identified GDF-15 as the sole independent predictor of DKD (p = 0.01). ROC curve analysis revealed that a GDF-15 cutoff value of ≥1890.51 pg/mL provided an AUC of 0.951, with a sensitivity of 94.2 % and specificity of 87.1 %.

CONCLUSION

Elevated GDF-15 levels are independently associated with an increased risk of DKD in T2DM patients, particularly in those with MAFLD. These findings highlight the potential of GDF-15 as an early biomarker for DKD.