Contemporary rates and predictors of fast progression of chronic kidney disease in adults with and without diabetes mellitus

Abstract

BackgroundChronic kidney disease (CKD) is highly prevalent but identification of patients at high risk for fast CKD progression before reaching end-stage renal disease in the short-term has been challenging. Whether factors associated with fast progression vary by diabetes status is also not well understood. We examined a large community-based cohort of adults with CKD to identify predictors of fast progression during the first 2 years of follow-up in the presence or absence of diabetes mellitus.MethodsWithin a large integrated healthcare delivery system in northern California, we identified adults with estimated glomerular filtration rate (eGFR) 30–59 ml/min/1.73 m2 by CKD-EPI equation between 2008 and 2010 who had no previous dialysis or renal transplant, who had outpatient serum creatinine values spaced 10–14 months apart and who did not initiate renal replacement therapy, die or disenroll during the first 2 years of follow-up. Through 2012, we calculated the annual rate of change in eGFR and classified patients as fast progressors if they lost > 4 ml/min/1.73 m2 per year. We used multivariable logistic regression to identify patient characteristics that were independently associated with fast CKD progression stratified by diabetes status.ResultsWe identified 36,195 eligible adults with eGFR 30–59 ml/min/1.73 m2 and mean age 73 years, 55% women, 11% black, 12% Asian/Pacific Islander and 36% with diabetes mellitus. During 24-month follow-up, fast progression of CKD occurred in 23.0% of patients with diabetes vs. 15.3% of patients without diabetes. Multivariable predictors of fast CKD progression that were similar by diabetes status included proteinuria, age ≥ 80 years, heart failure, anemia and higher systolic blood pressure. Age 70–79 years, prior ischemic stroke, current or former smoking and lower HDL cholesterol level were also predictive in patients without diabetes, while age 18–49 years was additionally predictive in those with diabetes.ConclusionsIn a large, contemporary population of adults with eGFR 30–59 ml/min/1.73 m2, accelerated progression of kidney dysfunction within 2 years affected ~ 1 in 4 patients with diabetes and ~ 1 in 7 without diabetes. Regardless of diabetes status, the strongest independent predictors of fast CKD progression included proteinuria, elevated systolic blood pressure, heart failure and anemia.

Impact of CKD Progression on Cardiovascular Disease Risk in a Contemporary UK Cohort of Individuals With Diabetes

“…In a recent global meta-analysis, the prevalence of CKD in Europe was approximately 12% across stages 3-5 and a greater proportion were women. 2 In the study be Go et al 28 from 2018, as well as our study, most T2DM subjects had advanced CKD, likely owing to the difficulty of identifying subjects during the more asymptomatic early stages of disease while in primary health care. Another important distinction among older T2DM subjects relates to hypertensive medication, for which a substantial gap exists between guideline recommendations and real-world prescribing patterns for RAASi among T2DM CKD patients with CVD comorbidities.…”

“…The risk for cardiorenal outcomes may improve over time if renal health is maintained, and especially so among T2DM populations, as was recently demonstrated in a US study that demonstrated reductions in CVD outcomes. 28 Along with unmeasured confounding, there were other relevant limitations to this study. Information on laboratory methods of measuring creatinine levels, which may influence eGFR levels to some extent, was not always available.…”

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

“…Rapid progression was de ned as a ΔeGFR of ≤-4ml/min/1.73m 2 /yr (i.e. losing more than 4ml/min/1.73m 2 /yr) [10,14]. Stable patients were de ned as a ΔeGFR of -0.5 to +0.5ml/min/1.73m 2 /yr as this small range centred on a zero rate of change.…”

“…One particular omission from current prediction tools involves quantifying the rate of change in renal function in patients over time, which can help conceptualise an individual's risk pro le more meaningfully [6,7]. Although a number of studies have explored the association of various risk factors on different rates of progression [8][9][10], there is a lack of data focusing exclusively on patients with a consistent linear rate of progression and the associations with adverse outcomes such as ESRD and mortality. These patients warrant attention as their linear eGFR trajectory represents a clear paradigm for understanding true CKD progression.…”

Effect of Metformin and Glimepiride Treatment on Some Biochemical Parameters in Diabetic Male Patients with Chronic Renal Failure

“…There are numbers of disorders or diseases could cause chronic kidney diseases, that effect on blood delivery to the kidneys via renal arteries. One of these diseases that causing kidney disease and risk on microvascular is diabetes mellitus [2]. and this risk increased with glucose abnormalities [3].…”