Rates of Estimated Glomerular Filtration Rate (eGFR) decline in patients with type 2 diabetes — ASN Events
  1. Schedule
  2. ADS Clinical Orals – Complications
  3. Rates of Estimated Glomerular Filtration Rate (eGFR) decline in patients with type 2 diabetes

Rates of Estimated Glomerular Filtration Rate (eGFR) decline in patients with type 2 diabetes (#15)

Richard J MacIsaac 1 , Karey Cheong 2 , Elif I Ekinci 2 3 , Shilpa Verma 2 , Erosha Premaratne 2 , Sianna Panagiotopoulos 2 , Scott Baker 2 , Sue Finch 4 , George Jerums 2
  1. Endocrinology and Diabetes, St Vincent's Hospital & University of Melbourne, Fitzroy, Victoria, Australia
  2. Endocrine Centre, Austin Health & University of Melbourne, Heidelberg West, Victoria, Australia
  3. Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
  4. Statistical Consulting Service, University of Melbourne, Parkville, Victoria, Australia

Background: The aim of this study was to determine the rate of eGFR decline in patients with type 2 diabetes with preserved renal function and various degrees of albuminuria.
Methods: This was a prospective, observational, cohort study of 364 patients with an initial eGFR > 60 ml/min/1.73m2 (estimated by the Chronic Kidney Disease Epidemiology Collaboration equation). The distribution of initial albumin excretion rates (AER) was normo- (n= 224, 62%), micro- (n= 112, 31%) and macroalbuminuria (n= 28, 8%). In addition to baseline AER, 21 explanatory clinical and biochemical variables were considered for the analysis of eGFR slopes. These included age, duration of diabetes, HbA1c levels, mean arterial blood pressure and use of renin-angiotensin modifying medications. Linear regression was used to estimate changes in eGFR over time from 2000-2001 to 2008-2009.
Results: Unadjusted and adjusted rates of eGFR decline (to account for differences in baseline characteristics among AER groups) are shown in the table. Patients with baseline macroalbuminuria had a significantly greater eGFR rate of decline than those with normo- or microalbuminuria. During the observational period at least 20% of patients with normo- or microalbuminuria had a rapid eGFR decline (defined as an average eGFR decline > 3.3 ml/min/1.73m2 per year) or one eGFR value < 60 ml/min/1.73m2.

321-MacIsaac.jpg

*ml/min/1.73m2 **p < 0.001 vs normo- and microalbuminuria
Conclusions: Although baseline macroalbuminuria was associated with greater rate of decline in eGFR, a substantial proportion of patients with type 2 diabetes and normo- or microalbuminuria still experience clinically meaningful reductions in eGFR.