Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes and Preserved Kidney Function

Zoppini, Giacomo; Targher, Giovanni; Chonchol, Michel; Ortalda, Vittorio; Negri, Carlo; Stoico, Vincenzo; Bonora, Enzo

doi:10.2215/cjn.07650711

Cited by 189 publications

(172 citation statements)

References 43 publications

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“…In our cohort of stable patients after MI, we found a yearly decline of kidney function of 2.0 ml/min per 1.73 m 2 in patients on placebo, a value similar to that observed in other older cohorts with cardiovascular disease or diabetes (4,20). Patients who increased their daily intake by an estimated 398 mg EPA-DHA (comparable with the recommended dietary allowance) for 40 months had a slower yearly decline of kidney function of 1.4 ml/min per 1.73 m 2 .…”

Section: Discussionsupporting

confidence: 88%

Effect of Omega-3 Fatty Acids on Kidney Function after Myocardial Infarction

Hoogeveen¹,

Geleijnse

Kromhout

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Kidney function gradually decreases with age, and myocardial infarction accelerates this deterioration. Omega-3 (n-3) fatty acids may slow down the decline of kidney function. The effect of marine and plant-derived n-3 fatty acids on kidney function in patients after myocardial infarction was examined.Design, setting, participants, & measurements In the Alpha Omega Trial, 2344 patients with history of myocardial infarction ages 60-80 years old (81% men) were randomized to one of four trial margarines. The patients received an additional targeted amount of 400 mg/d eicosapentaenoic acid and docosahexaenoic acid, 2 g/d a-linolenic acid, eicosapentaenoic acid-docosahexaenoic acid plus a-linolenic acid, or placebo for 40 months. Serum cystatin C and serum creatinine were assessed at baseline and after 40 months. Creatinine-cystatin C-based GFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration equation.Results Patients consumed 19.9 g margarine/d, providing an additional 239 mg/d eicosapentaenoic acid with 159 mg/d docosahexaenoic acid, 1.99 g/d a-linolenic acid, or both in the active treatment groups. After 40 months, compared with baseline, mean (6SD) creatinine-cystatin C-based GFR was 26.9 (612.6), 24.8 (613.4), 26.2 (612.8), and 26.0 (613.0) ml/min per 1.73 m 2 in the placebo, eicosapentaenoic acid-docosahexaenoic acid, a-linolenic acid, and eicosapentaenoic acid-docosahexaenoic acid plus a-linolenic acid groups, respectively. After 40 months, in patients receiving eicosapentaenoic acid-docosahexaenoic acid compared with placebo, the decline in creatinine-cystatin C-based GFR was 2.1 less (95% confidence interval, 0.6 to 3.6; P,0.01) ml/min per 1.73 m 2 ; other comparisons were not statistical significant. Odds ratios (95% confidence intervals) of incident CKD (,60 ml/min per 1.73 m 2 ) and rapid decline of kidney function ($3 ml/min per year) for eicosapentaenoic acid-docosahexaenoic acid compared with placebo were 0.83 (0.58 to 1.18) and 0.85 (0.67 to 1.08), respectively.Conclusions Long-term supplementation with 400 mg/d eicosapentaenoic acid-docosahexaenoic acid provides a small beneficial effect on kidney function in patients with a history of myocardial infarction.

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Section: Discussionsupporting

confidence: 88%

Effect of Omega-3 Fatty Acids on Kidney Function after Myocardial Infarction

Hoogeveen¹,

Geleijnse

Kromhout

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Urinary protein excretion at study initiation was also independently associated with annual Ccr declines. Proteinuria/albuminuria has been previously reported to accelerate the progression of type 2 DKD [6][7][8][9] and our result is thought to be consistent with previous reports. With regard to urinary protein excretion, proteinuria and albuminuria have been reported as major risk factors for the progression of type 2 DKD patients [14,15].…”

Section: Discussionsupporting

confidence: 94%

“…Thus far, several investigations of factors associated with kidney disease progression in type 2 diabetes have been reported. These studies have shown that age, HbA1c, insulin treatment, estimated glomerular filtration rate (eGFR) levels, systolic BP, hypertension, serum uric acid, serum albumin, hemoglobin, albuminuria, and proteinuria have significant relationships with the decline of renal function [6][7][8][9]. However, the nature of the relationship among the various factors and the decline of renal function varied from study to study, highlighting the need to better understand these associated risk factors.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the progression of renal dysfunction and the importance of salt restriction in patients with type 2 diabetic kidney disease

Kanauchi

Ookawara

et al. 2015

Clin Exp Nephrol

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“…Then, rapid eGFR decline, incidence of CKD, and incidence of albuminuria were modeled separately as a function of vitamin D at baseline using unconditional logistic regressions. Both eGFR and albuminuria have been previously associated with change in eGFR, rapid eGFR decline, and incident CKD (26,27). In the CoLaus study, the age-and sex-adjusted associations of baseline eGFR and albuminuria (independently of each other) with change in eGFR, rapid eGFR decline, and incident CKD were all highly significant (P,0.001); higher baseline eGFR was associated with greater eGFR loss, higher prevalence of rapid decline and lower CKD incidence; higher baseline albuminuria was associated with greater loss in eGFR, increased rapid decline, and greater CKD incidence.…”

Section: Statistical Analysesmentioning

confidence: 99%

Serum 25-Hydroxyvitamin D Level and Kidney Function Decline in a Swiss General Adult Population

Guessous

McClellan

Kleinbaum

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria.Design, setting, participants, & measurements Baseline (2003Baseline ( -2006 and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss .3 ml/min per 1.73 m 2 ), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors.Results Among the 4280 people included in the analysis, the mean6SD annual eGFR change was 20.5761.78 ml/min per 1.73 m 2 , and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was 20.005 ml/min per 1.73 m 2 (95% confidence interval, 20.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria.Conclusions The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.

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Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes and Preserved Kidney Function

Cited by 189 publications

References 43 publications

Effect of Omega-3 Fatty Acids on Kidney Function after Myocardial Infarction

Effect of Omega-3 Fatty Acids on Kidney Function after Myocardial Infarction

Factors affecting the progression of renal dysfunction and the importance of salt restriction in patients with type 2 diabetic kidney disease

Serum 25-Hydroxyvitamin D Level and Kidney Function Decline in a Swiss General Adult Population

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