Associations of Transforming Growth Factor-β (TGF-β) with Chronic Kidney Disease Progression in Patients Attending a Tertiary Hospital in Johannesburg, South Africa

Abstract

Introduction: The global prevalence of chronic kidney disease (CKD) is increasing and it is associated with higher mortality rates. Transforming growth factor-beta (TGF-β) can serve as a novel biomarker for early prediction of chronic kidney disease (CKD) progression. Methods: This was a prospective longitudinal study among black patients with CKD who attended the Charlotte Maxeke Johannesburg Academic Hospital between September 2019 and March 2022. Patients provided urine and blood samples for laboratory investigations at study entry (0) and at 24 months follow up. Baseline serum and urine TGF-β1, TGF-β2 and TGF-β3 levels were measured using ELISAs. Multivariable logistic regression analysis was utilized to determine if TGF-β isoforms could predict CKD progression. Results: A total of 312 patients were enrolled at baseline, of whom 275 (88.1%) had early-stage CKD (Stage 1–3). A majority, 95.2% (297/312), of the patients completed the study after 2 years follow up. The prevalence of CKD progression was 47.8% when measured by a sustained decline in eGFR of >4 mL/min/1.73 m2/year or more and 51.9% when measured by a change in uPCR > 30%. The patients with CKD progression had significantly lower eGFR and increased urine protein–creatinine ratios compared to non-progressors. Furthermore, comparing progressors with non-progressors, the median serum TGF-β1 was 21210 (15915–25745) ng/L vs. 24200 (17570–29560) ng/L and the median urine TGF-β3 was 17.5 (5.4–76.2) ng/L vs. 2.8 (1.8–15.3) ng/L, respectively. Baseline serum and urine TGF-β isoforms were unable to discriminate between CKD progressors and non-progressors after multivariable logistic regression analysis. Conclusions: Despite the multiple roles of TGF-β isoforms in kidney disease, baseline levels were not predictive of chronic kidney disease progression.