Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes
Abstract Background We examined the trajectory of estimated glomerular filtrate rate (eGFR), associated risk factors, and its relationship with end‐stage kidney disease (ESKD) among a multiethnic patient population with type 2 diabetes in Singapore. Methods A follow‐up study included 62 080 individu...
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| Format: | Article |
| Language: | English |
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Wiley
2024-09-01
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| Series: | Journal of Diabetes |
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| Online Access: | https://doi.org/10.1111/1753-0407.13523 |
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| author | Liang Feng Yong Mong Bee Xiuju Fu Jia Liang Kwek Choong Meng Chan Tazeen H. Jafar |
| author_facet | Liang Feng Yong Mong Bee Xiuju Fu Jia Liang Kwek Choong Meng Chan Tazeen H. Jafar |
| author_sort | Liang Feng |
| collection | DOAJ |
| description | Abstract Background We examined the trajectory of estimated glomerular filtrate rate (eGFR), associated risk factors, and its relationship with end‐stage kidney disease (ESKD) among a multiethnic patient population with type 2 diabetes in Singapore. Methods A follow‐up study included 62 080 individuals with type 2 diabetes aged ≥18 years in a multi‐institutional SingHealth Diabetes Registry between 2013 and 2019. eGFR trajectories were analyzed using latent class linear mixed models. Factors associated with eGFR trajectories were evaluated using multinomial logistic regression. The association of eGFR trajectories with ESKD was assessed via competing risk models. Results Trajectory of kidney function, determined by eGFR, was nonlinear. The trajectory pattern was classified as stable initially then gradual decline (75%), progressive decline (21.9%), and rapid decline (3.1%). Younger age, female sex, Malay ethnicity, lower‐income housing type, current smoking, higher glycated hemoglobin, lower low‐density lipoprotein, higher triglyceride, uncontrolled blood pressure, albuminuria, cardiovascular disease, hypertension, and higher eGFR levels each were associated with progressive or rapid decline. Compared with the trajectory of stable initially then gradual eGFR decline, progressive decline increased the hazard of ESKD by 6.14‐fold (95% confidence interval [CI]: 4.96–7.61)) and rapid decline by 82.55 folds (95% CI: 55.90–121.89). Conclusions Three nonlinear trajectory classes of kidney function were identified among multiethnic individuals with type 2 diabetes in Singapore. About one in four individuals had a progressive or rapid decline in eGFR. Our results suggest that eGFR trajectories are correlated with multiple social and modifiable risk factors and inform the risk of ESKD. |
| format | Article |
| id | doaj-art-2443afffd64d4f9581dabb11b8e9ea8e |
| institution | OA Journals |
| issn | 1753-0393 1753-0407 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes |
| spelling | doaj-art-2443afffd64d4f9581dabb11b8e9ea8e2025-08-20T01:56:06ZengWileyJournal of Diabetes1753-03931753-04072024-09-01169n/an/a10.1111/1753-0407.13523Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetesLiang Feng0Yong Mong Bee1Xiuju Fu2Jia Liang Kwek3Choong Meng Chan4Tazeen H. Jafar5Program in Health Services & Systems Research Duke‐NUS Medical School Singapore SingaporeDepartment of Endocrinology Singapore General Hospital Singapore SingaporeInstitute of High Performance Computing A*STAR Singapore SingaporeDepartment of Renal Medicine Singapore General Hospital Singapore SingaporeDepartment of Renal Medicine Singapore General Hospital Singapore SingaporeProgram in Health Services & Systems Research Duke‐NUS Medical School Singapore SingaporeAbstract Background We examined the trajectory of estimated glomerular filtrate rate (eGFR), associated risk factors, and its relationship with end‐stage kidney disease (ESKD) among a multiethnic patient population with type 2 diabetes in Singapore. Methods A follow‐up study included 62 080 individuals with type 2 diabetes aged ≥18 years in a multi‐institutional SingHealth Diabetes Registry between 2013 and 2019. eGFR trajectories were analyzed using latent class linear mixed models. Factors associated with eGFR trajectories were evaluated using multinomial logistic regression. The association of eGFR trajectories with ESKD was assessed via competing risk models. Results Trajectory of kidney function, determined by eGFR, was nonlinear. The trajectory pattern was classified as stable initially then gradual decline (75%), progressive decline (21.9%), and rapid decline (3.1%). Younger age, female sex, Malay ethnicity, lower‐income housing type, current smoking, higher glycated hemoglobin, lower low‐density lipoprotein, higher triglyceride, uncontrolled blood pressure, albuminuria, cardiovascular disease, hypertension, and higher eGFR levels each were associated with progressive or rapid decline. Compared with the trajectory of stable initially then gradual eGFR decline, progressive decline increased the hazard of ESKD by 6.14‐fold (95% confidence interval [CI]: 4.96–7.61)) and rapid decline by 82.55 folds (95% CI: 55.90–121.89). Conclusions Three nonlinear trajectory classes of kidney function were identified among multiethnic individuals with type 2 diabetes in Singapore. About one in four individuals had a progressive or rapid decline in eGFR. Our results suggest that eGFR trajectories are correlated with multiple social and modifiable risk factors and inform the risk of ESKD.https://doi.org/10.1111/1753-0407.13523albuminuriaestimated glomerular filtration ratelatent class linear mixed modelsrisk factorstrajectoriestype 2 diabetes |
| spellingShingle | Liang Feng Yong Mong Bee Xiuju Fu Jia Liang Kwek Choong Meng Chan Tazeen H. Jafar Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes Journal of Diabetes albuminuria estimated glomerular filtration rate latent class linear mixed models risk factors trajectories type 2 diabetes |
| title | Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes |
| title_full | Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes |
| title_fullStr | Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes |
| title_full_unstemmed | Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes |
| title_short | Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes |
| title_sort | kidney function trajectories associated factors and outcomes in multiethnic asian patients with type 2 diabetes |
| topic | albuminuria estimated glomerular filtration rate latent class linear mixed models risk factors trajectories type 2 diabetes |
| url | https://doi.org/10.1111/1753-0407.13523 |
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