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

Vistisen, Dorte; Andersen, Gregers; Hulmán, Ádám; Persson, Frederik; Rossing, Peter; Jørgensen, Marit Eika

doi:10.2337/dc19-0349

Cited by 106 publications

(80 citation statements)

References 34 publications

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“…On the other hand, the study by Levin et al [23] had the largest study population and enrolled stage 4 to 5 CKD patients, for whom diabetes was reported as a nonsigni cant factor (HR 0.82, 95% CI 0.56-1.20; P = 0.30). Previous studies have demonstrated large variation in GFR progression in persons with diabetes [36]. In the present study, individuals with diabetes were 8.74 times more likely to have CKD progression than individuals without diabetes.…”

Section: Graphsupporting

confidence: 51%

Non-linear progression of chronic kidney disease and associated factors in hypertensive patients: a 4-year cohort study

Silva¹,

Moreira²,

Silva³

et al. 2020

Preprint

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Background Recent studies suggest that the progression of chronic kidney disease (CKD) is not linear, but we do not have clear evidence on this issue, especially in hypertensive patients. We sought to evaluate the progression of CKD and associated factors over four years in a cohort of hypertensive patients. Methods We conducted a prospective cohort study during the years 2012 and 2016, with hypertensive patients diagnosed with CKD (n = 113). The progression of CKD was assessed through the evolution of the glomerular filtration rate (GFR) and the change in the stage of CKD between 2012 and 2016. Sociodemographic, economic, lifestyle, clinical, anthropometric, and biochemical variables were evaluated. The strength of the association between CKD progression and explanatory variables was assessed by odds ratio (OR) and their respective 95% confidence intervals using univariate and multivariate logistic regression. Results Regarding progression, 78.1% of the CKD patients did not progress over four years. When assessing the CKD trajectory (2012–2016) through the evolution of GFR, there was a mean reduction of 1.3 mL/min/1.73m² in four years. In the group that progressed, there was a reduction of 13 mL/min/1.73m², while in the group that did not progress, there was an increase of 2 mL/min/1.73m². In the multivariate analyses, age (p = 0.047), diabetes mellitus (DM) (p = 0.042), and urea (p = 0.050) were independently associated with CKD progression. Conclusions The findings of the present study showed a non-linear progression of CKD over the four years, contrary to what is traditionally expected. Age, DM and urea were independently associated with CKD progression.

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Section: Graphsupporting

confidence: 51%

Non-linear progression of chronic kidney disease and associated factors in hypertensive patients: a 4-year cohort study

Silva¹,

Moreira²,

Silva³

et al. 2020

Preprint

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“…There is a predictable decline in the kidney function related to aging; the annual age-related decline in eGFR from age 30 years is believed to be ± 1 mL/min/1.73 m 2 in healthy population (21)(22)(23), this GFR declines by about 8-10 ml/min/1.73 m 2 per decade (24,25), by other side, a linear decline in eGFR over time is often observed (26) in patients with diabetes or HTN, the decline in persons with diabetes range from ± 2-3 mL/min/1.73 m 2 per year (27). In patients with RC and ICD, previous reports have used de nitions such as a decrease of 1 ml/min/year (5,11,12) in a time period of 5 to 10 years, a decrease of > 25% (15,19) in eGFR from baseline, or a decline > 10% in eGFR (11,14).…”

Section: Discussionmentioning

confidence: 99%

Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

Chevarria

Ebad

Hamill

et al. 2020

Preprint

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Background. Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion, RC is associated with long-term morbidity, renal function deterioration and mortality. Our aim was to identify risk factors associated with postoperative long-term renal function decline and mortality. Methods. Retrospective study in patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We include patients who had assessment for at least two years post procedure and confirmed live status. We assessed the estimated glomerular filtration rate (eGFR) preoperatively, at first and second year, renal function decline > 10 ml/min/1.73 m2, start dialysis and mortality. Logistic regression analyses were applied to assess risk factors associated, a significant p-value < 0.05 was considered. Results. We included 264 patients, with median age 68.3 years, 73,7% males, main diagnose was bladder cancer 93.3%, TNM stages were grouped in T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73 m2 and after 2 years 58.2 ml/min/1.73 m2 (p:0.009), 5.6% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73 m2. Risk factors associated with ESKD included age (HR:1.13, CI95% 1.05–1.22), preoperative eGFR (HR:1.04, CI95% 1.01–1.07). Overall mortality was 43.2%, 75.9% at 5 and 10 years respectively, risk factors were age (HR:1.1, CI95% 1.04–1.18), preoperative eGFR (HR:1.03, CI95% 1.01–1.06) and male gender (HR:14.8, CI95% 1.1–192). Conclusions. Patients with RC have risk of progressive renal function deterioration and high mortality and the main risk factors associated were age, sex, and preoperative eGFR. Regular monitoring of renal function will permit early diagnosis and treatment.

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“…Currently, patients with diabetics are becoming progressively older and elderly in many countries. Additionally, these patients are frequently with normal or nonalbuminuria in their DKD progression, even in the progression to ESKD by the end (21). Therefore, caution should be used in extending these findings to the diabetic population as whole.…”

Section: Discussionmentioning

confidence: 99%

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

et al. 2019

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Objective: This study aimed to identify the risk factors for a rapid decline in the estimated glomerular filtration rate (eGFR) in Chinese patients with type 2 diabetes and biopsy-proven diabetic kidney disease (DKD). Method:This was a retrospective cohort study. Patients with biopsy-proven DKD who had been followed-up for at least 1 year were enrolled. Baseline clinicopathological data and serum creatinine levels that had been measured at least three times during follow-up in our hospital were collected. Patients were allocated to two groups of rapid decliners and slow decliners according to the median eGFR slope. The associations between potential risk factors and rapid eGFR decline were analyzed using logistic regression.Results: A total of 128 eligible patients were enrolled and they had a mean age of 51.5 ± 10.7 years. During a median follow-up of 2 years, the median eGFR slope was −8.1 ± 14.4 mL/min/1.73 m 2 /year. The eGFR decline was significantly faster in patients with a family history of diabetes in first-degree relatives, nephrotic-range proteinuria, higher grades of glomerular pathology, and interstitial inflammation. No differences in the rate of the eGFR decline were observed in subgroups created according to sex, age, hypertension, glycosylated hemoglobin, diabetic retinopathy, interstitial fibrosis, and tubular atrophy. Logistic regression indicated that a family history of diabetes was independently associated with a rapid decline in eGFR, even after adjustment for factors including baseline eGFR and proteinuria. Conclusion:A family history of diabetes in first-degree relatives is independently associated with a rapid decline in eGFR in the current relatively young studied patients. Our findings suggested that early diagnosis and treatment is important for these patients.

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

Cited by 106 publications

References 34 publications

Non-linear progression of chronic kidney disease and associated factors in hypertensive patients: a 4-year cohort study

Non-linear progression of chronic kidney disease and associated factors in hypertensive patients: a 4-year cohort study

Long-term renal function and mortality after radical cystectomy and ileal conduit formation.

Implications of a Family History of Diabetes and Rapid eGFR Decline in Patients With Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease

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