Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study

Warren, Bethany; Rebholz, Casey M.; Sang, Yingying; Lee, Alexandra K.; Coresh, Josef; Selvin, Elizabeth; Grams, Morgan E.

doi:10.2337/dc18-0277

Cited by 45 publications

(47 citation statements)

References 28 publications

(27 reference statements)

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“…A previous analysis of the African American Study of Kidney Disease and Hypertension (AASK) trial found that almost 42% of the eGFR trajectories were nonlinear, but this was not a study exclusively including persons with diabetes (8). Studies among persons with diabetes or stratified by diabetes status show a lower probability of nonlinear eGFR trajectories (7,9,19). Our study was additionally stratified both by diabetes type and by albuminuria status and further adjusted for various time-varying confounders.…”

Section: Discussionmentioning

confidence: 80%

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Progressive Decline in Estimated Glomerular Filtration Rate in Patients With Diabetes After Moderate Loss in Kidney Function—Even Without Albuminuria

et al. 2019

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Persons with diabetes but no chronic kidney disease (CKD) and without albuminuria have the same age-related decline in kidney function as the background population. Whether this also applies following moderate loss in kidney function is unknown. We quantified the impact of albuminuria status on the development of estimated glomerular filtration rate (eGFR) trajectories following CKD stage 3 (CKD3) and assessed potential heterogeneous development patterns among the subgroup with normoalbuminuria. RESEARCH DESIGN AND METHODS We used repeated clinical measures during up to 16 years of follow-up in 935 persons with type 1 diabetes and 1,984 with type 2 diabetes. Trajectories of eGFR by diabetes type and albuminuria status following CKD3 were estimated with spline mixed-effects models with adjustment for relevant confounders. Latent class trajectory modeling was used to find distinct patterns of eGFR development in the subgroups with normoalbuminuria. RESULTS Mean annual declines in eGFR for normo-, micro-and macroalbuminuria the first 10 years following CKD3 were 1.9, 2.3, and 3.3 mL/min/1.73 m 2 in type 1 diabetes and 1.9, 2.1, and 3.0 in type 2 diabetes, respectively. For normoalbuminuria, two distinct eGFR patterns were found, one with accelerated declining eGFR levels. This specific progression pattern was associated with less use of lipid-lowering treatment, renin-angiotensin system blockers, and other antihypertensive treatment. CONCLUSIONS Our results support a diabetes-dependent decline in kidney function without albuminuria following CKD3, with a subgroup showing a progressive decline. Furthermore, this group seems to be undertreated in terms of cardioprotective and renal protective treatment and suggests that increased attention should be drawn to normoalbuminuric diabetic kidney disease.

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Section: Discussionmentioning

confidence: 80%

“…A linear decline in eGFR over time is often assumed (7), but while this may be true in some groups of persons with diabetes, others have nonlinear patterns of development (8,9). For the ability to detect true nonlinear development patterns, multiple repetitive measurements of eGFRs over longer periods of time are needed.…”

mentioning

confidence: 99%

Progressive Decline in Estimated Glomerular Filtration Rate in Patients With Diabetes After Moderate Loss in Kidney Function—Even Without Albuminuria

et al. 2019

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“…Suppression of the Progression of Renal dysfunction in Patients with T2DM: It has been reported that the progression of renal dysfunction in patients with T2DM is two times faster than that in those without T2DM [13], and the severity of the renal dysfunction is greater in those patients with T2DM, with an excessive risk of death from any cause and cardiovascular death that increases up to approximately 30-fold as high as the risk among patients without T2DM [14]. In this study, the progression of renal dysfunction in the S group was significantly more suppressed than that in the NS group (Fig.…”

Section: Controls and Treatment Of T2dm And The Risk Factors In Patiementioning

confidence: 99%

Impact of Cardiovascular Screening Tests in Patients with Type 2 Diabetes Mellitus without Previous Histories of Cardiovascular Disease: 5-year Clinical Outcomes.

Antoku¹,

Takemoto

Mito³

et al. 2020

Preprint

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Background We previously reported that, among the asymptomatic patients with type 2 diabetes mellitus (T2DM) without history of cardiovascular disease (CVD), up to 19% of the patients with myocardial ischemia were detected by cardiovascular screening tests (CVSTs). We concluded that the CVSTs in patients with T2DM may be one of the most effective strategies to find CVD in those patients. Thus, the aim of the study was to assess the long-term clinical outcomes of CVSTs in patients with T2DM without previous histories of CVD. Methods Six hundred fifty-seven out-patients with T2DM who received CVSTs at least more than one time or not at all from April in 2014 to March in 2019 were defined as the S group or NS group, respectively. The data in 2104 and 2018 were collected from the medical records, and compared between the S and NS groups. Results This study revealed that, in the out-patients with T2DM in our hospital over those 5 years; 1) the frequency of receiving CVSTs was significantly increasing, 2) in accordance with that increase, the frequency of the internal use for CVD of statins, anti-platelets, and renin-angiotensin system inhibitors, which are well-known as medications for preventing CVD, was significantly increasing, 3) however, there was only a small increase in the internal use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptors, which are well-known to suppress cardiovascular events in patients with T2DM, 4) LDL-cholesterol and triglycerides significantly improved more in the S group than the NS group, 5) highly sensitive C-protein, which is one of the strongest predictors of CVD, was significantly suppressed by CVSTs, 6) the progression of renal dysfunction was significantly more suppressed in the S group than the NS group, 7) in an inverse proportion to the CVST increase, the frequency of acute coronary syndrome, cerebral infarctions, 4-point major adverse cardiovascular events, and admissions due to heart failure were significantly decreasing, and 8) finally, the frequency of all-cause mortality was significantly suppressed during those 5 years. Conclusions Thus, it may be important to continue CVSTs in out-patients with T2DM without a previous history of CVD for several years.

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“…We model the progression of diabetic renal disease by modeling the trajectories of relevant variables, including glomerular filtration rate (GFR), SCr, and urine albumin-to-creatinine ratio (UACR). GFR trajectories are estimated using findings from the diabetes cohort of the Atherosclerosis Risk in Communities (ARIC) study, 42 in particular, the results reported by Warren et al 43 Risk factors for a steeper GFR decline include black race, SBP ‡140 mmHg, HbA1c ‡9%, insulin use, and current tobacco smoking. 43 SCr is calculated from a patient's age, race, gender, and estimated GFR in each simulation month using the four-variable MDRD study equation.…”

Section: Nephropathy Modulementioning

confidence: 99%

“…GFR trajectories are estimated using findings from the diabetes cohort of the Atherosclerosis Risk in Communities (ARIC) study, 42 in particular, the results reported by Warren et al 43 Risk factors for a steeper GFR decline include black race, SBP ‡140 mmHg, HbA1c ‡9%, insulin use, and current tobacco smoking. 43 SCr is calculated from a patient's age, race, gender, and estimated GFR in each simulation month using the four-variable MDRD study equation. 44 UACR progression is modeled using the RECODe for microalbuminuria (UACR 30-300 mg/g or 3.4-34 mg/mmol) and macroalbuminuria (UACR >300 mg/g or >34 mg/mmol).…”

Section: Nephropathy Modulementioning

confidence: 99%

Development and Validation of PREDICT-DM: A New Microsimulation Model to Project and Evaluate Complications and Treatments of Type 2 Diabetes Mellitus

Kazemian

Wexler

Fields

et al. 2019

Diabetes Technology & Therapeutics

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Background: Type 2 diabetes mellitus (T2DM) affects *30 million people in the United States and *400 million people worldwide, numbers likely to increase due to the rising prevalence of obesity. We sought to design, develop, and validate PREDICT-DM (PRojection and Evaluation of Disease Interventions, Complications, and Treatments-Diabetes Mellitus), a state-transition microsimulation model of T2DM, incorporating recent data. Methods: PREDICT-DM is populated with natural history, risk factor, and outcome data from large-scale cohort studies and randomized clinical trials. The model projects diabetes-relevant outcomes, including cardiovascular and renal disease outcomes, and 5/10-year survival. We assessed the model validity against 62 endpoints from ACCORD (Action to Control Cardiovascular Risk in Diabetes), VADT (Veterans Affairs Diabetes Trial), and Look AHEAD trials via several comparative statistical methods, including mean absolute percentage error (MAPE), Bland-Altman graphs, and Kaplan-Meier curves. Results: For the comparison between simulated and observed outcomes of the intervention/control arms of the trial, the MAPE was 19%/25% (ACCORD), 29%/20% (VADT), and 42%/10% (Look AHEAD). The Bland-Altman's 95% limit of agreement was 0.02 (ACCORD), 0.03 (VADT), and 0.01 (Look AHEAD), and the mean difference (95% confidence interval) for the comparison between PREDICT-DM and trial endpoints was 0.0025 (-0.0018 to 0.0070) for ACCORD,-0.0067 (-0.0137 to 0.0002) for VADT, and-0.0033 (-0.0067 to 0.00002) for Look AHEAD, indicating an adequate model fit to the data. The model-driven Kaplan-Meier curves were similarly close to those previously published. Conclusions: PREDICT-DM can reasonably predict clinical outcomes from ACCORD and other clinical trials of U.S. patients with T2DM. This model may be leveraged to inform clinical strategy questions related to the management and care of T2DM in the United States.

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Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study

Cited by 45 publications

References 28 publications

Progressive Decline in Estimated Glomerular Filtration Rate in Patients With Diabetes After Moderate Loss in Kidney Function—Even Without Albuminuria

Progressive Decline in Estimated Glomerular Filtration Rate in Patients With Diabetes After Moderate Loss in Kidney Function—Even Without Albuminuria

Impact of Cardiovascular Screening Tests in Patients with Type 2 Diabetes Mellitus without Previous Histories of Cardiovascular Disease: 5-year Clinical Outcomes.

Development and Validation of PREDICT-DM: A New Microsimulation Model to Project and Evaluate Complications and Treatments of Type 2 Diabetes Mellitus

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