Soluble Urokinase Plasminogen Activator Receptor and Sirtuin 1 as Biomarkers of Disease Severity and Progression in Children with Chronic Kidney Disease​

<title>Abstract</title> <p> <bold>Background</bold> : Cardiovascular (CV) disease is the leading cause of morbidity and mortality in children with chronic kidney disease (CKD), driven by systemic inflammation and endothelial dysfunction. Soluble urokinase plasminogen activator receptor (suPAR) and Sirtuin 1 (SIRT1) are promising biomarkers of these pathways, but their utility in pediatric CKD, particularly in relation to CV involvement, has not been systematically evaluated. <bold>Methods</bold> : We compared serum suPAR and SIRT1 levels between 49 children with CKD and 20 healthy controls. CKD was staged per KDIGO criteria, and CV involvement was assessed using pulse wave velocity, augmentation index, and echocardiographic left ventricular mass index. Correlations between biomarker levels, kidney function parameters, CV measures, and disease progression phenotype were analyzed. <bold>Results</bold> : Serum suPAR and SIRT1 levels did not differ significantly between CKD and control groups, and receiver operating characteristic analysis showed limited diagnostic value for both (AUC 0.475 and 0.443, respectively). However, suPAR varied significantly across CKD stages (p=0.004), correlating positively with estimated glomerular filtration rate (r=0.531, p&lt;0.001) and inversely with creatinine (r=- 0.390, p=0.014), with a paradoxical decline from Stage 2 to Stage 5. SIRT1 remained stable across stages and showed no correlation with kidney function. Neither biomarker correlated significantly with arterial stiffness parameters or hypertension status. <bold>Conclusions</bold> : suPAR and SIRT1 lack diagnostic value for pediatric CKD but appear to be complementary indicators of disease severity (suPAR) and possibly adaptive cellular response (SIRT1), warranting further prospective evaluation. </p>