Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes.

Abstract

INTRODUCTION:

Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD.

RESEARCH DESIGN AND METHODS:

Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk.

RESULTS:

Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m2/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5-5 mL/min/1.73 m2/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m2/year compared with those with a minor change in UACR and eGFR.

CONCLUSIONS:

Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.

• Authors: Megumi Oshima, Tadashi Toyama, Akinori Hara, Miho Shimizu, Shinji Kitajima, Yasunori Iwata, Norihiko Sakai, Kengo Furuichi, Masakazu Haneda, Tetsuya Babazono, Hiroki Yokoyama, Kunitoshi Iseki, Shin-Ichi Araki, Toshiharu Ninomiya, Shigeko Hara, Yoshiki Suzuki, Masayuki Iwano, Eiji Kusano, Tatsumi Moriya, Hiroaki Satoh, Hiroyuki Nakamura, Hirofumi Makino, Takashi Wada
• Journal: BMJ open diabetes research & care (BMJ Open Diabetes Res Care) Vol. 9 Issue 1 (06 2021) ISSN: 2052-4897 [Electronic] England
• PMID: 34193460 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Albuminuria (epidemiology)
• Diabetes Mellitus, Type 2 (complications, epidemiology)
• Glomerular Filtration Rate
• Humans
• Kidney
• Kidney Failure, Chronic (epidemiology, etiology)