Association of Circulating Carbohydrate Antigen 19-9 Level with Type 2 Diabetic Kidney Disease in Chinese Adults: A Cross-Sectional Study

Figures & data

Table 1 Characteristics of Study Participants

Variables	Non-DKD	DKD	P value
	(n = 224)	(n = 178)
Male/female	128/96	91/87	0.229
Age (years)	55.07±11.66	57.34±10.30	0.042
BMI (kg/m^2)	24.03±3.44	25.18±3.71	0.002
NC (cm)	36.42±3.80	37.03±3.52	0.122
Diabetic duration (years)	6.74±6.72	9.31±7.20	<0.0001
Co-resident population (n)	3.68±1.78	3.83±1.94	0.596
Current smoking, n (%)	37 (16.52)	32 (17.98)	0.700
Current drinking, n (%)	70 (31.25)	52 (29.21)	0.660
Education, n (%)
High school or further	77 (34.38)	58 (32.58)	0.706
Less than high school	147 (65.62)	120 (67.42)
Family income, n (%)
Low	85 (37.95)	70 (39.33)	0.890
Medium	139 (62.05)	106 (59.55)
High	0 (0)	2 (1.12)
Sleep quality, n (%)
Good	133 (59.38)	109 (61.24)	0.705
Poor	91 (40.63)	69 (38.76)
SBP (mmHg)	130.60±19.80	141.36±22.93	<0.0001
DBP (mmHg)	76.99±11.11	81.77±11.86	<0.0001
FBG (mmol/L)	9.29±3.30	10.08±4.53	0.122
PBG (mmol/L)	14.89±4.80	15.44±4.84	0.175
HAb1c (%)	9.91±2.73	9.76±2.50	0.568
FCP (ng/mL)	1.75±1.27	1.81±1.29	0.666
TC (mmol/L)	4.66±1.45	5.45±5.58	0.033
TG (mmol/L)	2.00±1.54	2.51±1.84	<0.0001
HDL-C (mmol/L)	1.20±0.37	1.09±0.30	0.005
LDL-C (mmol/L)	2.72±0.94	2.93±1.28	0.070
AIP	0.36±0.77	0.67±0.74	<0.0001
AC	3.21±0.60	4.41±7.09	<0.0001
Cr (μmol/L)	62.75±21.72	80.13±53.17	0.003
eGFR (mL/min/1.73 m^2)	102.02±20.44	89.81±28.64	<0.0001
UACR (mg/g)	14.44±7.22	615.46±114.27	<0.0001
WBC (*10^9 /L)	6.83±2.23	7.35±2.42	0.022
CA19-9 (U/ mL)	21.23±17.30	29.61±23.17	<0.0001

Notes: Data were represented as mean ± standard deviation (SD) or number (percentages).

Abbreviations: DKD, diabetic kidney disease; BMI, body mass index; NC, neck circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; PBG, 2h postprandial blood glucose; HbA1c, glycated hemoglobin A1c; FCP, fasting C-peptide; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; AIP, atherogenic index of plasma; AC, atherogenic coefficient; Cr, creatinine; eGFR, estimated glomerular filtration rate; UACR, urinary albumin-to-creatinine ratio; WBC, white blood cell; CA 19-9, carbohydrate antigen 19-9.

Table 2 Association of Circulating CA19-9 with DKD-Related Parameters

Variables	r	P value	Adjusted r	Adjusted P value
Gender	0.080	0.111	–	–
Age	0.065	0.196	–	–
BMI	−0.015	0.764	–	–
Diabetic duration	0.082	0.158	–	–
NC	−0.010	0.856	0.073	0.246
Co-resident population	−0.74	0.152	−0.057	0.367
Current smoking	0.015	0.761	0.047	0.420
Current drinking	0.030	0.547	0.059	0.319
Education	0.005	0.915	−0.071	0.259
Family income	0.039	0.440	0.094	0.132
Sleep quality	−0.005	0.922	0.058	0.353
SBP	0.136	0.007	0.183	0.003
DBP	0.103	0.040	0.164	0.009
FBG	0.127	0.011	0.164	0.008
PBG	0.110	0.028	0.168	0.007
HAb1c	0.157	0.002	0.168	0.007
FCP	−0.001	0.977	0.079	0.209
TC	0.118	0.019	0.101	0.106
TG	0.177	<0.0001	0.163	0.009
HDL-C	−0.120	0.017	−0.211	0.001
LDL-C	0.068	0.174	0.097	0.121
AIP	0.215	<0.0001	0.254	<0.0001
AC	0.236	<0.0001	0.255	<0.0001
Cr	0.085	0.089	0.240	<0.0001
eGFR	−0.152	0.002	−0.289	<0.0001
UACR	0.184	<0.0001	0.249	<0.0001
WBC	0.087	0.081	0.126	0.045

Notes: Adjusted r: r value after controlling for sex, age, BMI, and duration of diabetes. Adjusted P value: P value after controlling for sex, age, BMI, and duration of diabetes.

Abbreviations: CA 19-9, carbohydrate antigen 19-9; DKD, diabetic kidney disease; BMI, body mass index; NC, neck circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; PBG, 2h postprandial blood glucose; HbA1c, glycated hemoglobin A1c; FCP, fasting C-peptide; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; AIP, atherogenic index of plasma; AC, atherogenic coefficient; Cr, creatinine; eGFR, estimated glomerular filtration rate; UACR, urinary albumin-to-creatinine ratio; WBC, white blood cell.

Table 3 Univariate and Multivariate Logistic Analysis of Factors Associated with DKD

Variables	Univariate Analysis			Multivariate Analysis
	B	OR (95% CI)	P	B	OR (95% CI)	P
Gender	−0.243	0.784 (0.528–1.165)	0.229
Age	0.019	1.019 (1.001–1.037)	0.043
Diabetic duration	0.056	1.058 (1.021–1.095)	0.002
NC	0.045	1.046 (0.988–1.107)	0.123
BMI	0.090	1.094 (1.034–1.159)	0.002
Current smoking	0.102	1.108 (0.658–1.864)	0.700
Current drinking	−0.097	0.908 (0.591–1.395)	0.659
Education	−0.086	0.918 (0.604–1.394)	0.688
Co-resident population	0.045	1.046 (0.937–1.168)	0.424
Family income	0.072	1.075 (0.752–1.535)	0.693
Sleep quality	−0.026	0.974 (0.684–1.388)	0.886
SBP	0.024	1.024 (1.014–1.034)	<0.0001
DBP	0.036	1.037 (1.019–1.056)	<0.0001
FBG	0.052	1.054 (1.001–1.110)	0.047
PBG	0.024	1.024 (0.983–1.067)	0.253
HAb1c	−0.022	0.978 (0.907–1.055)	0.567
FCP	0.032	1.033 (0.884–1.207)	0.685
TC	0.214	1.239 (1.063–1.443)	0.006
TG	0.185	1.203 (1.061–1.364)	0.004
HDL-C	−0.971	0.379 (0.206–0.697)	0.002
LDL-C	0.173	1.188 (0.991–1.425)	0.062
AIP	0.551	1.735 (1.314–2.292)	<0.0001
AC	0.234	1.264 (1.106–1.444)	0.001
CA 19-9	0.021	1.022 (1.011–1.033)	<0.0001	0.021	1.021 (1.005–1.037)	0.009
WBC	0.099	1.104 (1.011–1.205)	0.027

Notes: B is the standardized coefficient and measures the influence of each variables on DKD.

Abbreviations: OR, Odds ratios; CI, confidence intervals; CA 19-9, carbohydrate antigen 19-9; DKD, diabetic kidney disease; NC, neck circumference; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; PBG, 2h postprandial blood glucose; HbA1c, glycated hemoglobin A1c; FCP, fasting C-peptide; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; AIP, atherogenic index of plasma; AC, atherogenic coefficient; WBC, white blood cell.

Table 4 Adjusted ORs and 95% CIs for DKD According to Quartiles of Circulating CA19-9

Characteristics	Circulating CA19-9 Quartiles				P for trend
	Q1 (n=100)	Q2 (n=101)	Q3 (n=101)	Q4 (n=100)
	0.57–11.49	11.50–18.94	18.95–30.60	30.61–33.48
Model 1	1	1.505 (0.848–2.672)	1.331 (0.748–2.370)	3.313 (1.854–5.918)	<0.0001
Model 2	1	1.558 (0.741–3.277)	1.653 (0.755–3.617)	3.925 (1.839–8.379)	0.001
Model 3	1	1.380 (0.608–3.133)	1.271 (0.530–3.051)	2.895 (1.141–7.344)	0.043
Model 4	1	1.381 (0.608–3.137)	1.239 (0.512–2.997)	2.821 (1.092–7.285)	0.049
Model 5	1	1.296 (0.564–2.979)	1.187 (0.480–2.936)	2.864 (1.101–7.450)	0.046

Notes: Data are expressed as OR (95% CI) +P value, unless stated otherwise. Model 1 unadjusted; Model 2 adjusted for gender, age, body mass index, neck circumference, diabetic duration, co-resident population, current smoking, current drinking, education, family income, and sleep quality; Model 3 adjusted for factors listed in Model 2 plus systolic and diastolic blood pressure, fasting blood glucose, 2h postprandial blood glucose, glycated hemoglobin A1c, fasting C-peptide, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol; Model 4 adjusted for factors listed in Model 3 plus white blood cell; Model 5 adjusted for atherogenic index of plasma and atherogenic coefficient in addition to covariates as in Model 4.

Abbreviations: ORs, Odds ratios; CI, confidence intervals; Q, quartile; DKD, diabetic kidney disease; CA 19-9, carbohydrate antigen 19-9.

Figure 1 ROC analysis of circulating CA19-9 to indicate DKD for T2DM patients. AUC = 0.619; 95% CI, 0.564–0.674; P < 0.001; identified circulating CA19-9 cutoff value = 25.09 u/mL; Youden index = 0.192; sensitivity: 43.8%; specificity: 75.4%.