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

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 SatohHiroyuki Nakamura, Hirofumi Makino, Takashi Wada

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article numbere002311
JournalBMJ Open Diabetes Research and Care
Volume9
Issue number1
DOIs
Publication statusPublished - Jun 30 2021

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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