Abstract: Objective  To investigate the predictive value of serum 4-hydroxynonenal (4-HNE) combined with apolipoprotein B (ApoB) for the progression to end-stage renal disease (ESRD) in chronic kidney disease (CKD) stage 3-4 patients with diabetic kidney disease (DKD).  Methods  A total of 126 CKD3-4 patients with DKD admitted from January 2021 to March 2023 were selected. They were divided into an ESRD group (n=46) and a control group (Con group, n=80) based on whether they progressed to ESRD within two years. The general data, biochemical indicators and serum 4-HNE were compared between the two groups. Binary Logistic regression model was used to analyze the influencing factors for the progression of CKD3～4 DKD to ESRD, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of clinical indicators.  Results  The levels of serum creatinine, blood urea nitrogen, apolipoprotein B (ApoB) and 4-HNE in the ESRD group were higher than those in the Con group (t/Z/F/χ²=2.594,3.313,5.945,8.539;P=0.011,0.001, <0.001, <0.001). Logistic regression analysis showed that ApoB (OR=2813.365, 95%CI: 13.184～600349.625) and 4-HNE (OR=23.923, 95%CI:6.236～91.777) were factors influencing the progression to ESRD within two years in patients with CKD G3～4 DKD. The area under the curve (AUC) of ApoB, 4-HNE, and their combination for predicting progression to ESRD was 0.866, 0.796, and 0.902, respectively, with the combined prediction showing a higher AUC than either indicator alone (Z=4.723,5.691;P=0.021,0.013).  Conclusion  Elevated serum 4-HNE and ApoB levels are influencing factors for the progression from CKD G3～4 DKD to ESRD. Combined detection of serum 4-HNE and ApoB has good predictive value for progression to ESRD within two years in patients with CKD G3～4 DKD.

Key words: Diabetic kidney disease, End-stage renal disease, 4-Hydroxynonenal, Apolipoprotein B