Open Access

Thomas Weinreich, Eric Seibert, E. Brohammer, Marcus Rüb, Frank Gehlen, Axel Sikora, Bernd Hohenstein

• Objective: Dickkopf 3 (DKK3) has been identified as a urinary biomarker. Values above 4000 pg/mg creatinine (Cr) were linked with a higher risk of short-term decline of kidney function (J Am Soc Nephrol 29: 2722–2733). However, as of today, there is little experience with DKK3 as a risk marker in everyday clinical practice. We used algorithm-based data analysis to evaluate the potential dependenceObjective: Dickkopf 3 (DKK3) has been identified as a urinary biomarker. Values above 4000 pg/mg creatinine (Cr) were linked with a higher risk of short-term decline of kidney function (J Am Soc Nephrol 29: 2722–2733). However, as of today, there is little experience with DKK3 as a risk marker in everyday clinical practice. We used algorithm-based data analysis to evaluate the potential dependence of DKK3 in a cohort from a large single center in Germany. Method: DKK3 was measured in all CKD patients in our center October 1 st 2018 till Dec. 31 2019, together with calculated GFR (eGFR) and urinary albumin/creatinine ratio (UACR). Kidney transplant patients were excluded. Until the end of follow-up Dec 31 st 2021, repeated measurements were performed for all parameters. Data analysis was performed using MD-Explorer (BioArtProducts, Rostock, Germany) and Python with multiple libraries. Linear regression models were applied in patients for DKK3, eGFR and UACR. Comparison of the models was performed with a twosided Kolmogorov-Smirnov test. Results: 1206 DKK3 measurements were performed in 1103 patients (621 male, age 70yrs, eGFR 29,41 ml/min/1.73qm, UACR 800 mg/g). 134 patients died during follow-up. DKK3 mean was 2905 pg/mg Cr (max. 20000, 75 % percentile 3800). 121 pts had DKK3 > 4000. At the end of follow-up 7 % of patients with DKK3 < 4000 (initial eGFR 17.6) versus 39.6 % of patients with DDK3 > 4000 (initial eGFR 15.7) underwent dialysis. Compared to eGFR and UACR at baseline, DKK3 > 4000 performed best to predict eGFR loss over the next 12 months. Conclusion: In this cohort of CKD patients, DKK3 > 4000 at baseline predicted the eGFR slope better than eGFR or UACR at baseline. DKK3 > 4000 reflected a higher risk of progression towards ESRD in patients with similar baseline eGFR levels.…