Long-term evolution of renal function in patients with type 2 diabetes mellitus: a registry-based retrospective cohort study

Abstract

ObjectivesTo picture the 10-year evolution of renal function in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) and to describe the risk factors for severe decline.SettingPrimary registration network with 97 general practitioners working in 55 practices sending routinely collected patient data.ParticipantsFrom the database, we selected all patients aged 40 years or older with T2DM and at least two creatinine measurements in two different years with an interval of at least 3 months. Based on the last available value of estimated glomerular filtration rate calculated by the modification of diet in renal disease (MDRD) equation, patients were divided into grades of CKD. Severe decline (decline of >4 mL/min/year) and ‘certain drop’ (CD, year-to-year decline >10 mL/min) were determined in patients with CKD. Determinants of severe decline and CD were investigated with logistic regression and longitudinal logistic regression analysis, respectively.Primary outcome measureKidney function (MDRD).Results4041 patients, 1980 women, were included. The mean age was 71 years, mean diabetes duration was 7.7 years; 1514 (38%) suffered from CKD, 231 (15%) presented with severe decline and 18% of the patients with CKD presented with two or more CDs. Younger age, male gender, mean glycated haemoglobin and a higher number of CDs were significantly associated with the presence of severe decline (p<0.05); statins and higher diastolic blood pressure were significantly associated with the absence of severe decline (p<0.001). ACE inhibitors, other antihypertensive drugs and antidiabetic drugs including insulin therapy were specific determinants of CD.ConclusionsCKD is highly prevalent in patients with T2DM; a minority of patients evolve into severe decline that is associated with younger age, male gender, ‘CD’ and manageable factors such as blood pressure, blood glucose, associated drugs prescriptions and statin therapy. Further prospective observational and experimental research is needed to clarify the nature of those associations.

Discordance in risk factors for the progression of diabetic retinopathy and diabetic nephropathy in patients with type 2 diabetes mellitus

“…However, some patients do not show any phenotype of DN, even in the presence of proliferative DR. Phenotypes of DN are renal dysfunction (eGFR <60 mL/min/1.73 m 2 ), albuminuria (urine ACR >30 mg/g creatinine) or both. In the present study, we defined the progression of DN as an eGFR decline >4% per year, in accordance with previous studies, because there is no definite criterion for the progression of DN. At baseline, as expected, eGFR was lower and urine ACR was higher in the DN progressors than in the DN non‐progressors.…”

Temporal variation of renal function in people with type 2 diabetes mellitus: A retrospective UK clinical practice research datalink cohort study

“…Previous research, including observational studies and a randomized controlled trial, has shown that eGFR tends to decline over time among patients with T2DM; some studies have found that groups of patients may experience varying rates of renal function decline, with some exhibiting rapid decline and others slower decline . The observational studies, in particular, have also reported differences in the rate of eGFR change based on certain patient characteristics including age, ethnicity, positive or negative proteinuria at baseline and hypertension.…”

“…Previous research has showed that renal function, as measured by estimated glomerular filtration rate (eGFR), can vary considerably, especially among people with diabetes . These studies have also suggested that eGFR improvement among people with T2DM is possible, leading to increased complexity when considering optimal treatment.…”

“…Previous research has showed that renal function, as measured by estimated glomerular filtration rate (eGFR), can vary considerably, especially among people with diabetes. [6][7][8][9][10][11][12][13][14] These studies have also suggested that eGFR improvement among people with T2DM is possible, 11 leading to increased complexity when considering optimal treatment. Published studies have tended to investigate renal variation at the population or category level, with one such study reporting eGFR trends in the UK.…”

Kidney manifestations of diabetes mellitus – A Review

“…More prospective observational studies are required to clarify the nature of the above associations. [19] It has been pointed out that some relationship exists between vitamin D (Vit-D), insulin secretion, IR and ß-cell function in T2DM patients; however, evidence linking Vit-D and T2DM are contradictory and standardized well controlled studies are required. As Vit-D influences the rennin-angiotensin system, inflammation and Mineral Bone Density (MBD), it may be associated with the cause and progression of CKD.…”