Objective:

To evaluate the clinical relevance of soluble ADAM10 (sADAM10) as a biomarker in chronic kidney disease (CKD) and kidney transplant recipients (KTR).

Approach:

• Study Design: A retrospective cohort study involving 488 participants: 145 KTR, 295 CKD patients, and 48 healthy controls (HC).
• Measurement: Plasma sADAM10 was measured using ELISA and correlated with renal function, laboratory parameters, and histopathological findings.
• Prognostic Analysis: Prognostic value was assessed using Kaplan-Meier analyses, restricted cubic spline (RCS) Cox regression, and incremental value assessment.

Key Findings:

• Plasma sADAM10 levels were significantly elevated in KTR and CKD patients compared to HC.
• In CKD, sADAM10 was independently associated with eGFR (standardized β = –0.24, P < 0.001).
• In KTR, sADAM10 was associated with neutrophil count (standardized β = 0.24, P = 0.034).
• Higher sADAM10 levels correlated with severity of interstitial fibrosis and tubular atrophy, tubular injury, and interstitial inflammation.
• sADAM10 provided incremental prognostic value for post-transplant infection risk beyond age and eGFR (C-index increase from 0.795 to 0.842; likelihood ratio P = 0.005).
• No independent association was found between sADAM10 and composite renal endpoint after adjusting for eGFR and proteinuria.

Interpretation:

Plasma sADAM10 is a context-dependent biomarker with specific associations related to renal dysfunction in CKD and inflammatory activation in KTR, as well as predicting post-transplant infection risk.

Limitations:

• The association of sADAM10 with renal outcomes is confounded by eGFR.
• The study is retrospective and may require validation in larger cohorts.

Conclusion:

Plasma sADAM10 shows potential for infection risk stratification in KTR.