Main Article Content
Abstract
Diabetic nephropathy is a leading cause of end-stage renal disease. Current diagnostic methods, which utilize conventional biomarkers, fail to adequately capture early-stage tubular epithelial cell dysfunction, a condition that likely occurs prior to glomerular damage. This study developed a comprehensive machine learning framework integrating multi-omics data to identify tubular epithelial cell-specific biomarkers for diabetic nephropathy. We systematically collected omics data from established public databases, analyzing 245 transcriptomic samples (18,632 features), 198 proteomic samples (4,521 features), and 167 metabolomic samples (812 features), resulting in an integrated dataset of 156 samples with 23,965 molecular features. Following stringent quality control, batch effect removal, and normalization, we implemented an ensemble learning approach combining Random Forest, Support Vector Machine, and XGBoost algorithms. The ensemble model achieved superior performance with 91.4% accuracy, 89.6% sensitivity, 92.8% specificity, and an AUC of 0.947, representing significant improvement over conventional clinical markers. We identified ten tubular epithelial cell-specific candidate biomarkers, with KIM-1 showing the highest importance score (0.092), followed by NGAL (0.087) and L-FABP (0.084). These markers demonstrated progressive upregulation throughout disease stages with 1.5-fold to 3.2-fold increases in advanced states. Analysis revealed perturbations in inflammatory response pathways, oxidative stress processes, and epithelial-to-mesenchymal transition. Independent cohort validation across three geographically distinct populations confirmed the robustness and generalizability of identified biomarkers. The findings demonstrate the potential of machine learning-based multi-omics integration for enhanced diabetic nephropathy detection and provide novel insights into tubular pathophysiology that could facilitate earlier intervention and personalized treatment strategies.
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Article Details
References
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References
Y. Chen, X. Liu, M. Shengbu, Q. Shi, S. Jiaqiu, and X. Lai, "Biomarkers: New Advances in Diabetic Nephropathy," Natural Product Communications, vol. 20, no. 2, p. 1934578X251321758, 2025. DOI:10.1177/1934578X251321758.
J. Rico-Fontalvo et al., "Novel Biomarkers of Diabetic Kidney Disease," Biomolecules, vol. 13, no. 4, p. 633, Mar 31 2023. DOI: 10.3390/biom13040633.
X. Shao et al., "Machine learning-based multi-omics models for diagnostic classification and risk stratification in diabetic kidney disease," Clin Transl Med, vol. 15, no. 1, p. e70133, Jan 2025. DOI: 10.1002/ctm2.70133.
C. Y. Jung and T. H. Yoo, "Pathophysiologic Mechanisms and Potential Biomarkers in Diabetic Kidney Disease," Diabetes Metab J, vol. 46, no. 2, pp. 181-197, Mar 2022. DOI: 10.4093/dmj.2021.0329.
M. Kiran, Y. Xie, N. Anjum, G. Ball, B. Pierscionek, and D. Russell, "Machine learning and artificial intelligence in type 2 diabetes prediction: a comprehensive 33-year bibliometric and literature analysis," Front Digit Health, vol. 7, p. 1557467, 2025. DOI: 10.3389/fdgth.2025.1557467.
N. Samsu, "Diabetic Nephropathy: Challenges in Pathogenesis, Diagnosis, and Treatment," Biomed Res Int, vol. 2021, no. 1, p. 1497449, 2021. DOI: 10.1155/2021/1497449.
G. Currie, G. McKay, and C. Delles, "Biomarkers in diabetic nephropathy: Present and future," World J Diabetes, vol. 5, no. 6, pp. 763-76, Dec 15 2014. DOI: 10.4239/wjd.v5.i6.763.
M. Lin et al., "Machine learning and multi-omics integration: advancing cardiovascular translational research and clinical practice," J Transl Med, vol. 23, no. 1, p. 388, Apr 2 2025. DOI: 10.1186/s12967-025-06425-2.
M. B. Lopes et al., "The Omics‐Driven Machine Learning Path to Cost‐Effective Precision Medicine in Chronic Kidney Disease," Proteomics, p. e202400108, 2024. DOI: https://doi.org/10.1002/pmic.202400108.
X. Liu et al., "Integrated multi-omics with machine learning to uncover the intricacies of kidney disease," Brief Bioinform, vol. 25, no. 5, p. bbae364, Jul 25 2024. DOI: 10.1093/bib/bbae364.
M. Concepcion et al., "Novel Biomarkers for the diagnosis of diabetic nephropathy," Caspian J Intern Med, vol. 15, no. 3, pp. 382-391, Summer 2024. DOI: 10.22088/cjim.15.3.382.
J. P. Joumaa et al., "Mechanisms, Biomarkers, and Treatment Approaches for Diabetic Kidney Disease: Current Insights and Future Perspectives," J Clin Med, vol. 14, no. 3, p. 727, Jan 23 2025. DOI: 10.3390/jcm14030727.
B. Yu et al., "Research progress on small extracellular vesicles in diabetic nephropathy," Front Cell Dev Biol, vol. 13, p. 1535249, 2025. DOI: 10.3389/fcell.2025.1535249.
M. M. Rinschen and J. Saez-Rodriguez, "The tissue proteome in the multi-omic landscape of kidney disease," Nat Rev Nephrol, vol. 17, no. 3, pp. 205-219, Mar 2021. DOI: 10.1038/s41581-020-00348-5.
S. Eddy, L. H. Mariani, and M. Kretzler, "Integrated multi-omics approaches to improve classification of chronic kidney disease," Nat Rev Nephrol, vol. 16, no. 11, pp. 657-668, Nov 2020. DOI: 10.1038/s41581-020-0286-5.
Q. Sha, J. Lyu, M. Zhao, H. Li, M. Guo, and Q. Sun, "Multi-Omics Analysis of Diabetic Nephropathy Reveals Potential New Mechanisms and Drug Targets," Front Genet, vol. 11, p. 616435, 2020. DOI: 10.3389/fgene.2020.616435.
H. Liu, J. Feng, and L. Tang, "Early renal structural changes and potential biomarkers in diabetic nephropathy," Front Physiol, vol. 13, p. 1020443, 2022. DOI: 10.3389/fphys.2022.1020443.
J. Yang, D. Liu, and Z. Liu, "Integration of Metabolomics and Proteomics in Exploring the Endothelial Dysfunction Mechanism Induced by Serum Exosomes From Diabetic Retinopathy and Diabetic Nephropathy Patients," Front Endocrinol (Lausanne), vol. 13, p. 830466, 2022. DOI: 10.3389/fendo.2022.830466.
Y.-Y. Yang, Z.-X. Gao, Z.-H. Mao, D.-W. Liu, Z.-S. Liu, and P. Wu, "Identification of ULK1 as a novel mitophagy-related gene in diabetic nephropathy," Frontiers in endocrinology, vol. 13, p. 1079465, 2023. DOI: 10.3389/fendo.2022.1079465.
C. Sabanayagam et al., "Prediction of diabetic kidney disease risk using machine learning models: A population-based cohort study of Asian adults," Elife, vol. 12, p. e81878, Sep 14 2023. DOI: 10.7554/eLife.81878.
F. Mesquita, J. Bernardino, J. Henriques, J. F. Raposo, R. T. Ribeiro, and S. Paredes, "Machine learning techniques to predict the risk of developing diabetic nephropathy: a literature review," J Diabetes Metab Disord, vol. 23, no. 1, pp. 825-839, Jun 2024. DOI: 10.1007/s40200-023-01357-4.
S. M. Swaminathan et al., "Novel biomarkers for prognosticating diabetic kidney disease progression," Int Urol Nephrol, vol. 55, no. 4, pp. 913-928, Apr 2023. DOI: 10.1007/s11255-022-03354-7.
C. Gluhovschi et al., "Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy," J Diabetes Res, vol. 2016, no. 1, p. 4626125, 2016. DOI: 10.1155/2016/4626125.
M. Colombo et al., "Serum kidney injury molecule 1 and β 2-microglobulin perform as well as larger biomarker panels for prediction of rapid decline in renal function in type 2 diabetes," Diabetologia, vol. 62, pp. 156-168, 2019. DOI: 10.1007/s00125-018-4741-9.
A. Alkhalaf et al., "Multicentric validation of proteomic biomarkers in urine specific for diabetic nephropathy," PLoS One, vol. 5, no. 10, p. e13421, Oct 20 2010. DOI: 10.1371/journal.pone.0013421.
M. Lindhardt et al., "Urinary proteomics predict onset of microalbuminuria in normoalbuminuric type 2 diabetic patients, a sub-study of the DIRECT-Protect 2 study," Nephrol Dial Transplant, vol. 32, no. 11, pp. 1866-1873, Nov 1 2017. DOI: 10.1093/ndt/gfw292.
M. Kammer et al., "Integrative analysis of prognostic biomarkers derived from multiomics panels helps discrimination of chronic kidney disease trajectories in people with type 2 diabetes," Kidney Int, vol. 96, no. 6, pp. 1381-1388, Dec 2019. DOI: 10.1016/j.kint.2019.07.025.
E. Soltani-Fard et al., "Urinary biomarkers in diabetic nephropathy," Clin Chim Acta, vol. 561, p. 119762, Jul 15 2024. DOI: 10.1016/j.cca.2024.119762.
J. G. Amatruda et al., "Biomarkers of Kidney Tubule Disease and Risk of End-Stage Kidney Disease in Persons With Diabetes and CKD," Kidney Int Rep, vol. 7, no. 7, pp. 1514-1523, Jul 2022. DOI: 10.1016/j.ekir.2022.03.033.
H. El Alami et al., "Meta-analysis of MTHFR C677T polymorphism and type 2 diabetes mellitus in MENA region," Diabetes Metab Syndr, vol. 18, no. 2, p. 102965, Feb 2024. DOI: 10.1016/j.dsx.2024.102965.
T. Sen et al., "Mechanisms of action of the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin on tubular inflammation and damage: A post hoc mediation analysis of the CANVAS trial," Diabetes Obes Metab, vol. 24, no. 10, pp. 1950-1956, Oct 2022. DOI: 10.1111/dom.14779.
D. J. Wexler et al., "Comparative Effects of Glucose-Lowering Medications on Kidney Outcomes in Type 2 Diabetes: The GRADE Randomized Clinical Trial," JAMA Intern Med, vol. 183, no. 7, pp. 705-714, Jul 1 2023. DOI: 10.1001/jamainternmed.2023.1487.
P. Bjornstad et al., "Insulin Secretion, Sensitivity, and Kidney Function in Young Individuals With Type 2 Diabetes," Diabetes Care, vol. 47, no. 3, pp. 409-417, Mar 1 2024. DOI: 10.2337/dc23-1818.
K. Kalantar-Zadeh, T. H. Jafar, D. Nitsch, B. L. Neuen, and V. Perkovic, "Chronic kidney disease," Lancet, vol. 398, no. 10302, pp. 786-802, Aug 28 2021. DOI: 10.1016/S0140-6736(21)00519-5.
M. C. Thomas, "Targeting the Pathobiology of Diabetic Kidney Disease," Adv Chronic Kidney Dis, vol. 28, no. 4, pp. 282-289, Jul 2021. DOI: 10.1053/j.ackd.2021.07.001.
N. M. Selby and M. W. Taal, "An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines," Diabetes Obes Metab, vol. 22 Suppl 1, pp. 3-15, Apr 2020. DOI: 10.1111/dom.14007.
H. J. L. Heerspink et al., "Canagliflozin and Kidney-Related Adverse Events in Type 2 Diabetes and CKD: Findings From the Randomized CREDENCE Trial," Am J Kidney Dis, vol. 79, no. 2, pp. 244-256 e1, Feb 2022. DOI: 10.1053/j.ajkd.2021.05.005.
D. K. McGuire et al., "Effects of empagliflozin on first and recurrent clinical events in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a secondary analysis of the EMPA-REG OUTCOME trial," Lancet Diabetes Endocrinol, vol. 8, no. 12, pp. 949-959, Dec 2020. DOI: 10.1016/S2213-8587(20)30344-2.
S. Shen, C. Ji, and K. Wei, "Cellular Senescence and Regulated Cell Death of Tubular Epithelial Cells in Diabetic Kidney Disease," Front Endocrinol (Lausanne), vol. 13, p. 924299, 2022. DOI: 10.3389/fendo.2022.924299.
Y. Wang, H. Hamid. Reconstructing pharmaceutical service competency framework: development of AI-informed competency indicators and localized practices in China. Future Technology, 4(2), 61–75. DOI: 10.55670/fpll.futech.4.2.7.