Abstract The identification of clinical predictors for the development of chronic kidney disease is a critical issue in the management of patients with type 2 diabetes mellitus. We evaluated 27,029 patients with type 2 diabetes mellitus and estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2 and normoalbuminuria from the database of the Italian Association of Clinical Diabetologists network. Primary outcomes were eGFR <60mL/min/1.73m2 and normoalbuminuria; albuminuria and eGFR ≥60mL/min/1.73m2 ; and eGFR <60mL/min/1.73m2 and albuminuria. Secondary outcomes were eGFR <60mL/min/1.73m2 and albuminuria. Measurements: eGFR from serum creatinine by chronic kidney disease epidemiology collaboration equation (CKD-EPI), urinary albumin excretion, HbA1c, triglycerides, highdensity lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c), blood pressure, and body mass index. Over a 4-year period, 33.2% of patients (n=8973) developed chronic kidney disease, 10.3% (n=2788) showed a decline in eGFR <60mL/min/1.73m2 , 18.4% (n=4978) developed albuminuria, and 4.5% (n=1207) developed both features. Relative risk ratios (RRRs) for age (1.37, P<0.001 by 5 years), sex (0.77, P<0.001 for being male), body mass index (1.03, P<0.001 by 1 kg/m2 ), triglycerides (1.02, P<0.001 by 10mg/dL), and LDL-c (0.97, P=0.004 by 10mg/dL) were independently related to the onset of eGFR reduction. Age (1.08, P<0.001 by 5 years), sex (1.36, P<0.001 for being male), body mass index (1.02, P<0.001 by 1 kg/ m2 ), triglycerides (1.01, P=0.02 by 10mg/dL), HDL-c, and LDL-c (0.97, P=0.008 and 0.99, P=0.003 by 5 and 10mg/dL, respectively) were related to the onset of albuminuria. HbA1c and the intensity of antihypertensive treatment showed a weaker association with renal outcome. Reduction in eGFR and albuminuria showed distinct sets of risk factors, suggesting that different mechanisms are involved in the development of these 2 components of diabetic kidney disease. Abbreviations: AMD = Associazione Medici Diabetologi, BP = blood pressure, CKD = chronic kidney disease, DKD = diabetic kidney disease, eGFR = estimated glomerular filtration rate, HDL-c = total and high density lipoprotein cholesterol, LDL-c = lowdensity lipoprotein cholesterol.
Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative
RUSSO, GIUSEPPINA;
2016-01-01
Abstract
Abstract The identification of clinical predictors for the development of chronic kidney disease is a critical issue in the management of patients with type 2 diabetes mellitus. We evaluated 27,029 patients with type 2 diabetes mellitus and estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2 and normoalbuminuria from the database of the Italian Association of Clinical Diabetologists network. Primary outcomes were eGFR <60mL/min/1.73m2 and normoalbuminuria; albuminuria and eGFR ≥60mL/min/1.73m2 ; and eGFR <60mL/min/1.73m2 and albuminuria. Secondary outcomes were eGFR <60mL/min/1.73m2 and albuminuria. Measurements: eGFR from serum creatinine by chronic kidney disease epidemiology collaboration equation (CKD-EPI), urinary albumin excretion, HbA1c, triglycerides, highdensity lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c), blood pressure, and body mass index. Over a 4-year period, 33.2% of patients (n=8973) developed chronic kidney disease, 10.3% (n=2788) showed a decline in eGFR <60mL/min/1.73m2 , 18.4% (n=4978) developed albuminuria, and 4.5% (n=1207) developed both features. Relative risk ratios (RRRs) for age (1.37, P<0.001 by 5 years), sex (0.77, P<0.001 for being male), body mass index (1.03, P<0.001 by 1 kg/m2 ), triglycerides (1.02, P<0.001 by 10mg/dL), and LDL-c (0.97, P=0.004 by 10mg/dL) were independently related to the onset of eGFR reduction. Age (1.08, P<0.001 by 5 years), sex (1.36, P<0.001 for being male), body mass index (1.02, P<0.001 by 1 kg/ m2 ), triglycerides (1.01, P=0.02 by 10mg/dL), HDL-c, and LDL-c (0.97, P=0.008 and 0.99, P=0.003 by 5 and 10mg/dL, respectively) were related to the onset of albuminuria. HbA1c and the intensity of antihypertensive treatment showed a weaker association with renal outcome. Reduction in eGFR and albuminuria showed distinct sets of risk factors, suggesting that different mechanisms are involved in the development of these 2 components of diabetic kidney disease. Abbreviations: AMD = Associazione Medici Diabetologi, BP = blood pressure, CKD = chronic kidney disease, DKD = diabetic kidney disease, eGFR = estimated glomerular filtration rate, HDL-c = total and high density lipoprotein cholesterol, LDL-c = lowdensity lipoprotein cholesterol.Pubblicazioni consigliate
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