TY - JOUR
T1 - Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes
AU - Oshima, Megumi
AU - Toyama, Tadashi
AU - Hara, Akinori
AU - Shimizu, Miho
AU - Kitajima, Shinji
AU - Iwata, Yasunori
AU - Sakai, Norihiko
AU - Furuichi, Kengo
AU - Haneda, Masakazu
AU - Babazono, Tetsuya
AU - Yokoyama, Hiroki
AU - Iseki, Kunitoshi
AU - Araki, Shin Ichi
AU - Ninomiya, Toshiharu
AU - Hara, Shigeko
AU - Suzuki, Yoshiki
AU - Iwano, Masayuki
AU - Kusano, Eiji
AU - Moriya, Tatsumi
AU - Satoh, Hiroaki
AU - Nakamura, Hiroyuki
AU - Makino, Hirofumi
AU - Wada, Takashi
N1 - Funding Information:
Funding This study was supported by Grant-in-Aids for Diabetic Nephropathy Research and for Diabetic Nephropathy and Nephrosclerosis Research, from the Ministry of Health, Labour and Welfare of Japan and the Ministry of Education, Science, Sports and Culture, Japan.
Publisher 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.
PY - 2021/6/30
Y1 - 2021/6/30
N2 - 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.
AB - 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.
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U2 - 10.1136/bmjdrc-2021-002311
DO - 10.1136/bmjdrc-2021-002311
M3 - Article
C2 - 34193460
AN - SCOPUS:85110133932
VL - 9
JO - BMJ Open Diabetes Research and Care
JF - BMJ Open Diabetes Research and Care
SN - 2052-4897
IS - 1
M1 - e002311
ER -
