Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes
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...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002311.full |
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| author | Toshiharu Ninomiya Hiroki Yokoyama Shin-ichi Araki Hirofumi Makino Kunitoshi Iseki Kengo Furuichi Megumi Oshima Tadashi Toyama Takashi Wada Miho Shimizu Hiroyuki Nakamura Norihiko Sakai Yasunori Iwata Shinji Kitajima Akinori Hara Yoshiki Suzuki Hiroaki Satoh Tetsuya Babazono Tatsumi Moriya Masayuki Iwano Masakazu Haneda Shigeko Hara Eiji Kusano |
| author_facet | Toshiharu Ninomiya Hiroki Yokoyama Shin-ichi Araki Hirofumi Makino Kunitoshi Iseki Kengo Furuichi Megumi Oshima Tadashi Toyama Takashi Wada Miho Shimizu Hiroyuki Nakamura Norihiko Sakai Yasunori Iwata Shinji Kitajima Akinori Hara Yoshiki Suzuki Hiroaki Satoh Tetsuya Babazono Tatsumi Moriya Masayuki Iwano Masakazu Haneda Shigeko Hara Eiji Kusano |
| author_sort | Toshiharu Ninomiya |
| collection | DOAJ |
| description | 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 m2/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 m2/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 m2/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. |
| format | Article |
| id | doaj-art-a6b8fcd3a8b4437693eb1907fd5f855d |
| institution | OA Journals |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-a6b8fcd3a8b4437693eb1907fd5f855d2025-08-20T02:34:33ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002311Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetesToshiharu Ninomiya0Hiroki Yokoyama1Shin-ichi Araki2Hirofumi Makino3Kunitoshi Iseki4Kengo Furuichi5Megumi Oshima6Tadashi Toyama7Takashi Wada8Miho Shimizu9Hiroyuki Nakamura10Norihiko Sakai11Yasunori Iwata12Shinji Kitajima13Akinori Hara14Yoshiki Suzuki15Hiroaki Satoh16Tetsuya Babazono17Tatsumi Moriya18Masayuki Iwano19Masakazu Haneda20Shigeko Hara21Eiji Kusano22Department of Epidemiology and Public Health, Kyushu University, Fukuoka, JapanJiyugaoka Medical Clinic, Obihiro, JapanDepartment of Internal Medicine, Division of Nephrology, Wakayama Medical University, Wakayama, Japan3Okayama University, Okayama, JapanOkinawa Heart and Renal Association, Naha, JapanDepartment of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, JapanDepartment of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, JapanDepartment of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan9 Division of Nephrology, Kanazawa University Hospital, Ishikawa, JapanDepartment of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan1 AAV Biology Section, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USADepartment of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, JapanDivision of Infection Control, Kanazawa University, Ishikawa, JapanDepartment of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, JapanDepartment of Environmental and Preventive Medicine, Kanazawa University, Kanazawa, JapanHealth Administration Center, Niigata University, Niigata, JapanDepartment of Metabolism and Endocrinology, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, JapanDiabetes Center, Tokyo Women’s Medical University, Shinjuku-ku, JapanHealth Care Centre, Kitasato University, Tokyo, JapanDivision of Nephrology, University of Fukui, Fukui, JapanDepartment of Medicine, Asahikawa Medical University, Asahikawa, JapanOkinaka Memorial Institute for Medical Research, Minato-ku, JapanDepartment of Internal Medicine, Jichi Medical University, Shimotsuke, JapanIntroduction 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 m2/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 m2/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 m2/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.https://drc.bmj.com/content/9/1/e002311.full |
| spellingShingle | Toshiharu Ninomiya Hiroki Yokoyama Shin-ichi Araki Hirofumi Makino Kunitoshi Iseki Kengo Furuichi Megumi Oshima Tadashi Toyama Takashi Wada Miho Shimizu Hiroyuki Nakamura Norihiko Sakai Yasunori Iwata Shinji Kitajima Akinori Hara Yoshiki Suzuki Hiroaki Satoh Tetsuya Babazono Tatsumi Moriya Masayuki Iwano Masakazu Haneda Shigeko Hara Eiji Kusano Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes BMJ Open Diabetes Research & Care |
| title | Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| title_full | Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| title_fullStr | Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| title_full_unstemmed | Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| title_short | Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| title_sort | combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes |
| url | https://drc.bmj.com/content/9/1/e002311.full |
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