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Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: The CRIC (Chronic Renal Insufficiency Cohort) Study.
Am J Kidney Dis. 2018 11; 72(5):653-661.AJ

Abstract

BACKGROUND

Reduced glomerular filtration rate (GFR) in the absence of albuminuria is a common manifestation of chronic kidney disease (CKD) in diabetes. However, the frequency with which it progresses to end-stage kidney disease (ESKD) is unknown.

STUDY DESIGN

Multicenter prospective cohort study.

SETTING & PARTICIPANTS

We included 1,908 participants with diabetes and reduced GFR enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study in the United States.

PREDICTORS

Urinary albumin and protein excretion.

OUTCOMES

Incident ESKD, CKD progression (ESKD or ≥50% reduction in estimated GFR [eGFR] from baseline), and annual rate of decline in kidney function.

MEASUREMENTS

ESKD was ascertained by self-report and by linkage to the US Renal Data System. We used Cox proportional hazards modeling to estimate the association of albuminuria and proteinuria with incident ESKD or CKD progression and linear mixed-effects models to assess differences in eGFR slopes among those with and without albuminuria.

RESULTS

Mean eGFR at baseline was 41.2mL/min/1.73m2. Normal or mildly increased 24-hour urinary albumin excretion (<30mg/d) at baseline was present in 28% of participants, but in only 5% of those progressing to ESKD. For those with baseline normal or mildly increased albuminuria, moderately increased albuminuria (albumin excretion, 30-299mg/d), and 2 levels of severely increased albuminuria (albumin excretion, 300-999 and ≥1,000mg/d): crude rates of ESKD were 7.4, 34.8, 78.7, and 178.7 per 1,000 person-years, respectively; CKD progression rates were 17.0, 61.4, 130.5, and 295.1 per 1,000 person-years, respectively; and annual rates of eGFR decline were -0.17, -1.35, -2.74, and -4.69mL/min/1.73m2, respectively.

LIMITATIONS

We were unable to compare the results with healthy controls.

CONCLUSIONS

In people with diabetes with reduced eGFRs, the absence of albuminuria or proteinuria is common and carries a much lower risk for ESKD, CKD progression, or rapid decline in eGFR compared with those with albuminuria or proteinuria. The rate of eGFR decline in normoalbuminuric CKD was similar to that reported for the general diabetic population.

Authors+Show Affiliations

Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: digsu.koye@baker.edu.au.Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia.Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29784612

Citation

Koye, Digsu N., et al. "Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: the CRIC (Chronic Renal Insufficiency Cohort) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 72, no. 5, 2018, pp. 653-661.
Koye DN, Magliano DJ, Reid CM, et al. Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: The CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2018;72(5):653-661.
Koye, D. N., Magliano, D. J., Reid, C. M., Jepson, C., Feldman, H. I., Herman, W. H., & Shaw, J. E. (2018). Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: The CRIC (Chronic Renal Insufficiency Cohort) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 72(5), 653-661. https://doi.org/10.1053/j.ajkd.2018.02.364
Koye DN, et al. Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2018;72(5):653-661. PubMed PMID: 29784612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Progression of Nonalbuminuric CKD to End-Stage Kidney Disease in People With Diabetes: The CRIC (Chronic Renal Insufficiency Cohort) Study. AU - Koye,Digsu N, AU - Magliano,Dianna J, AU - Reid,Christopher M, AU - Jepson,Christopher, AU - Feldman,Harold I, AU - Herman,William H, AU - Shaw,Jonathan E, Y1 - 2018/05/18/ PY - 2017/11/07/received PY - 2018/02/27/accepted PY - 2018/5/23/pubmed PY - 2019/9/5/medline PY - 2018/5/23/entrez KW - CKD progression KW - Nonalbuminuric KW - chronic kidney disease KW - diabetes KW - diabetic kidney disease KW - eGFR decline KW - eGFR slope KW - end-stage kidney disease (ESKD) KW - estimated glomerular filtration rate (eGFR) KW - incident ESKD KW - kidney function KW - kidney impairment KW - macroalbuminuria KW - microalbuminuria KW - nonproteinuric KW - normoalbuminuria KW - proteinuria KW - reduced eGFR SP - 653 EP - 661 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 72 IS - 5 N2 - BACKGROUND: Reduced glomerular filtration rate (GFR) in the absence of albuminuria is a common manifestation of chronic kidney disease (CKD) in diabetes. However, the frequency with which it progresses to end-stage kidney disease (ESKD) is unknown. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: We included 1,908 participants with diabetes and reduced GFR enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study in the United States. PREDICTORS: Urinary albumin and protein excretion. OUTCOMES: Incident ESKD, CKD progression (ESKD or ≥50% reduction in estimated GFR [eGFR] from baseline), and annual rate of decline in kidney function. MEASUREMENTS: ESKD was ascertained by self-report and by linkage to the US Renal Data System. We used Cox proportional hazards modeling to estimate the association of albuminuria and proteinuria with incident ESKD or CKD progression and linear mixed-effects models to assess differences in eGFR slopes among those with and without albuminuria. RESULTS: Mean eGFR at baseline was 41.2mL/min/1.73m2. Normal or mildly increased 24-hour urinary albumin excretion (<30mg/d) at baseline was present in 28% of participants, but in only 5% of those progressing to ESKD. For those with baseline normal or mildly increased albuminuria, moderately increased albuminuria (albumin excretion, 30-299mg/d), and 2 levels of severely increased albuminuria (albumin excretion, 300-999 and ≥1,000mg/d): crude rates of ESKD were 7.4, 34.8, 78.7, and 178.7 per 1,000 person-years, respectively; CKD progression rates were 17.0, 61.4, 130.5, and 295.1 per 1,000 person-years, respectively; and annual rates of eGFR decline were -0.17, -1.35, -2.74, and -4.69mL/min/1.73m2, respectively. LIMITATIONS: We were unable to compare the results with healthy controls. CONCLUSIONS: In people with diabetes with reduced eGFRs, the absence of albuminuria or proteinuria is common and carries a much lower risk for ESKD, CKD progression, or rapid decline in eGFR compared with those with albuminuria or proteinuria. The rate of eGFR decline in normoalbuminuric CKD was similar to that reported for the general diabetic population. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/29784612/Risk_of_Progression_of_Nonalbuminuric_CKD_to_End_Stage_Kidney_Disease_in_People_With_Diabetes:_The_CRIC__Chronic_Renal_Insufficiency_Cohort__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(18)30607-3 DB - PRIME DP - Unbound Medicine ER -