Background and Aims:
Significant associations between IgG glycans and kidney function in type 1 diabetes and nondiabetic individuals have been described. IgG glycans may also have biomarker potential for the course of kidney function in type 2 diabetes. We investigated the prospective relation between IgG N-glycosylation and kidney function in T2D.

Methods:
In the DiaGene case-control study (n=1886 patients) with mean prospective follow-up of 6.93 years, we analyzed the association of eGFR change during total follow-up time and per year, with 24 direct and 34 derived IgG N-glycan profiles. We used linear regression adjusted for age, sex, their interaction, smoking, MAP, BMI, Hba1c, duration of diabetes, nonHDL and HDL. Correction for multiple comparisons was performed with the Benjamin-Hochberg method.

Results
Two derived IgG N-glycan profiles were significantly associated with kidney function over time. Monogalactosylated (G1n) and agalactosylated structures (G0n) were associated with improved and declined kidney function, respectively. Eleven traits were associated with eGFR change per year. Traits associated with faster decrease in eGFR were GP6, bisecting fucosylated structures (FBS2/FS2, FBS2/(FS2+FBS2), FBn, FBG1n/G1n, FBG2n/G2n, FBn/Fn and FBn/Fntotal) and monosialylation of fucosylated non-bisecting digalactosylated structures (FG2S1/(FG2+FG2S1+FG2S2)). Traits associated with less eGFR decline were fucosylated neutral glycans without bisection (Fn) and monogalactosylated structures (FG1n/G1n).

Conclusions:
Low IgG galactosylation, is associated with a greater decrease in kidney function over time. Also, bisection is associated with faster decline, while fucosylation is associated with less kidney function decline. All changes associated with worse kidney function prognosis in T2DM are in line with a proinflammatory IgG glycosylation state.

04 - THE ASSOCIATION OF THE IGG N-GLYCOME WITH THE COURSE OF KIDNEY FUNCTION IN TYPE 2 DIABETES MELLITUS