Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes.
Diabetes Care. 2020 01; 43(1):122-129.DC

Abstract

OBJECTIVE

We aimed to investigate the rate of progression of nonalbuminuric chronic kidney disease (CKD) to end-stage kidney disease (ESKD) or death or major cardiovascular events (MACE) compared with albuminuric and nonalbuminuric phenotypes.

RESEARCH DESIGN AND METHODS

We included 10,185 participants with type 2 diabetes enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Based on baseline albuminuria and estimated glomerular filtration rate (eGFR), participants were classified as having no kidney disease (no CKD), albuminuria only (albuminuric non-CKD), reduced eGFR only (nonalbuminuric CKD), or both albuminuria and reduced eGFR (albuminuric CKD). The rate of eGFR decline and hazard ratios (HRs) for ESKD or death or MACE were calculated.

RESULTS

For individuals with no CKD and those with nonalbuminuric CKD, the rates of eGFR decline were -1.31 and -0.60 mL/min/year, respectively (P < 0.001). In competing-risks analysis (no CKD as the reference), HRs for ESKD indicated no increased risk for nonalbuminuric CKD (0.76 [95% CI 0.34, 1.70]) and greatest risk for albuminuric CKD (4.52 [2.91, 7.01]). In adjusted Cox models, HRs for death and MACE were highest for albumuniuric CKD (2.38 [1.92, 2.90] and 2.37 [1.89, 2.97], respectively) and were higher for albuminuric non-CKD (1.82 [1.59, 2.08] and 1.88 [1.63, 2.16], respectively) than for those with nonalbuminuric CKD (1.42 [1.14, 1.78] and 1.44 [1.13, 1.84], respectively).

CONCLUSIONS

Those with nonalbuminuric CKD showed a slower rate of decline in eGFR than did any other group; however, these individuals still carry a greater risk for death and MACE than do those with no CKD.

Links

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Authors+Show Affiliations

Buyadaa O

Department of Clinical Diabetes and Epidemiology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia oyunchimeg.buyadaa@baker.edu.au. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Magliano DJ

Department of Clinical Diabetes and Epidemiology, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Salim A

Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia. Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia.

Koye DN

Shaw JE

MeSH

AdultAgedAged, 80 and overAlbuminuriaCardiovascular DiseasesCause of DeathDiabetes Mellitus, Type 2Diabetic AngiopathiesDiabetic NephropathiesDisease ProgressionFemaleGlomerular Filtration RateHumansKidney Failure, ChronicMaleMiddle AgedRenal Insufficiency, ChronicRisk Factors

Pub Type(s)

Journal Article

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31796570

Citation

Buyadaa, Oyunchimeg, et al. "Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes." Diabetes Care, vol. 43, no. 1, 2020, pp. 122-129.

Buyadaa O, Magliano DJ, Salim A, et al. Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes. Diabetes Care. 2020;43(1):122-129.

Buyadaa, O., Magliano, D. J., Salim, A., Koye, D. N., & Shaw, J. E. (2020). Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes. Diabetes Care, 43(1), 122-129. https://doi.org/10.2337/dc19-1438

Buyadaa O, et al. Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes. Diabetes Care. 2020;43(1):122-129. PubMed PMID: 31796570.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes. AU - Buyadaa,Oyunchimeg, AU - Magliano,Dianna J, AU - Salim,Agus, AU - Koye,Digsu N, AU - Shaw,Jonathan E, Y1 - 2019/12/03/ PY - 2019/07/22/received PY - 2019/10/04/accepted PY - 2019/12/5/pubmed PY - 2020/9/15/medline PY - 2019/12/5/entrez SP - 122 EP - 129 JF - Diabetes care JO - Diabetes Care VL - 43 IS - 1 N2 - OBJECTIVE: We aimed to investigate the rate of progression of nonalbuminuric chronic kidney disease (CKD) to end-stage kidney disease (ESKD) or death or major cardiovascular events (MACE) compared with albuminuric and nonalbuminuric phenotypes. RESEARCH DESIGN AND METHODS: We included 10,185 participants with type 2 diabetes enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Based on baseline albuminuria and estimated glomerular filtration rate (eGFR), participants were classified as having no kidney disease (no CKD), albuminuria only (albuminuric non-CKD), reduced eGFR only (nonalbuminuric CKD), or both albuminuria and reduced eGFR (albuminuric CKD). The rate of eGFR decline and hazard ratios (HRs) for ESKD or death or MACE were calculated. RESULTS: For individuals with no CKD and those with nonalbuminuric CKD, the rates of eGFR decline were -1.31 and -0.60 mL/min/year, respectively (P < 0.001). In competing-risks analysis (no CKD as the reference), HRs for ESKD indicated no increased risk for nonalbuminuric CKD (0.76 [95% CI 0.34, 1.70]) and greatest risk for albuminuric CKD (4.52 [2.91, 7.01]). In adjusted Cox models, HRs for death and MACE were highest for albumuniuric CKD (2.38 [1.92, 2.90] and 2.37 [1.89, 2.97], respectively) and were higher for albuminuric non-CKD (1.82 [1.59, 2.08] and 1.88 [1.63, 2.16], respectively) than for those with nonalbuminuric CKD (1.42 [1.14, 1.78] and 1.44 [1.13, 1.84], respectively). CONCLUSIONS: Those with nonalbuminuric CKD showed a slower rate of decline in eGFR than did any other group; however, these individuals still carry a greater risk for death and MACE than do those with no CKD. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/31796570/Risk_of_Rapid_Kidney_Function_Decline_All_Cause_Mortality_and_Major_Cardiovascular_Events_in_Nonalbuminuric_Chronic_Kidney_Disease_in_Type_2_Diabetes_ DB - PRIME DP - Unbound Medicine ER -

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Risk of Rapid Kidney Function Decline, All-Cause Mortality, and Major Cardiovascular Events in Nonalbuminuric Chronic Kidney Disease in Type 2 Diabetes.Diabetes Care. 2020 01; 43(1):122-129.DC