Adropin as a Marker in Type 2 Diabetes: Insights Into Diabetic Kidney Disease and Chronic Heart Failure

Type 2 diabetes mellitus (T2DM) is frequently associated with diabetic kidney disease (DKD) and chronic heart failure (CHF), conditions that share overlapping pathophysiological mechanisms. Adropin, a liver- and brain-derived peptide hormone, has emerged as a novel biomarker involved in metabolic regulation, endothelial function, and inflammation. However, its role in differentiating stages of T2DM-related complications remains underexplored.

This study aimed to evaluate serum adropin levels in T2DM patients with and without DKD and to assess its association with coexisting CHF.

This was an observational case-control study which was conducted over a period of one year and included 111 participants divided into three groups: healthy controls, T2DM without nephropathy, and T2DM with nephropathy (with and without CHF). Serum adropin levels were measured using enzyme-linked immunosorbent assay (ELISA), and comprehensive clinical, biochemical, and echocardiographic assessments were done.

Serum adropin levels were significantly reduced in T2DM patients (0.61 ± 0.13 ng/mL, p < 0.0001), with the lowest levels observed in those with both DKD and CHF (0.47 ± 0.12 ng/mL, p < 0.0001) compared to controls (0.76 ± 0.10 ng/mL, p < 0.0001). A progressive decline in adropin was noted with worsening glycemic control, renal dysfunction, chronic inflammation, and cardiac dysfunction. Significant inverse correlations were found between adropin and glycosylated hemoglobin (HbA1c) (r = -0.31), urinary albumin creatinine ratio (ACR) (r = -0.59), C - reactive protein (CRP) (r = -0.37), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (r = -0.44), while positive correlations existed with estimated glomerular filtration rate (eGFR) (r = +0.31). Receiver operating characteristic (ROC) curve analysis revealed high diagnostic accuracy for DKD (0.50 ng/mL, AUC  (area under curve) = 0.946), DKD with CHF (0.44 ng/mL, AUC = 0.965), and T2DM with CHF (0.54 ng/mL, AUC = 0.887).

The study demonstrated that serum adropin levels decline progressively with worsening cardiorenal-metabolic parameters. These findings reinforce the role of adropin as a sensitive marker of endothelial and metabolic dysfunction, especially in patients with coexisting T2DM, DKD, and CHF. Given its strong correlation with markers of glycemic control, renal impairment, and inflammation, adropin may serve as a noninvasive biomarker for early detection and risk stratification.