Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes. Issue 1 (30th June 2021)

• Record Type: Journal Article
• Authors: Oshima, Megumi; Toyama, Tadashi; Hara, Akinori; Shimizu, Miho; Kitajima, Shinji; Iwata, Yasunori; Sakai, Norihiko; Furuichi, Kengo; Haneda, Masakazu; Babazono, Tetsuya; Yokoyama, Hiroki; Iseki, Kunitoshi; Araki, Shin-ichi; Ninomiya, Toshiharu; Hara, Shigeko; Suzuki, Yoshiki; Iwano, Masayuki; Kusano, Eiji; Moriya, Tatsumi; Satoh, Hiroaki; Nakamura, Hiroyuki; Makino, Hirofumi; Wada, Takashi
• Is Part Of: BMJ open diabetes research and care. Volume 9:Issue 1(2021)
• Publication Date: 2021-06-30
• Subjects: function -- albuminuria -- kidney function tests -- diabetes mellitus -- type 2; Diabetes -- Periodicals; 616.462005
• DOI: 10.1136/bmjdrc-2021-002311
• Languages: English
• ISSNs: 2052-4897

Abstract

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 m 2 /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 m 2 /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 m 2 /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.