Accurate prediction of kidney function decline remains a major challenge in T2DM. A cohort study presented at the American Diabetes Association (ADA) Scientific Sessions evaluated the role of urinary Dickkopf-3 (uDKK3), a tubular epithelial–derived glycoprotein and marker of tubular injury, as a prognostic biomarker for kidney and cardiovascular outcomes.

The study analyzed 3,232 adults with T2DM managed in primary care settings. The primary composite endpoint included a sustained decline in estimated glomerular filtration rate (eGFR) of ≥40%, a ≥30% increase in albuminuria or change in albuminuria class, progression to end-stage kidney disease, or kidney failure–related death. Over a median follow-up of 4.26 years, uDKK3 levels >200 pg/mg creatinine were associated with a higher risk of reaching the composite endpoint.

uDKK3 also improved prediction of one-year eGFR decline beyond conventional markers such as eGFR and albuminuria. Elevated uDKK3 levels correlated with an increased incidence of cardiovascular events and all-cause mortality. These findings suggest that uDKK3 measurement in primary care can help identify high-risk patients with T2DM who may benefit from earlier, intensified management or referral to nephrology care.