Diagnosing diabetic nephropathy by 1H NMR metabonomics of serum

Object: The most severe complication of type 1 diabetes (T1DM) is diabetic nephropathy. It is associated with a high risk of cardiovascular complications and premature death and requires early detection to be efficiently treated. The clinical practice to diagnose diabetic nephropathy is also a non-optimal and tedious set up based on albumin excretion rate in multiple overnight or 24h urine samples. Conversely, in this study, these independent diagnostic data are used to provide a realistic testing case for applying H-1 NMR metabonomics of serum in a diagnostic fashion. \ Materials and Methods: 182 T1DM and 21 non-diabetic (non-T1DM) individuals were studied. The H-1 NMR of serum at 500 MHz was targeted at two molecular windows: lipoprotein lipids and low-molecular-weight metabolites. Results: T1DM and non-T1DM individuals were exclusively separated by H-1 NMR. For diabetic nephropathy diagnosis in the T1DM patients, H-1 NMR data (and clinical biochemistry data) gave a sensitivity of 87.1% (83.9%) and a specificity of 87.7% (95.9%). The predictive values of positive and negative tests were 89.0% (95.5%) and 83.6% (79.2%), respectively. Conclusions: H-1 NMR metabonomics clearly distinguishes metabolic characteristics of T1DM and appears approximately as good a means to diagnose diabetic nephropathy from serum as an advanced set of biochemical variables.