Introduction Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD. Research design and methods Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk. Results Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m2/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5–5 mL/min/1.73 m2/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m2/year compared with those with a minor change in UACR and eGFR. Conclusions Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes. All data relevant to the study, details of the study protocol and statistical analysis plan will be available on reasonable request.

中文翻译：

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蛋白尿和肾功能的综合变化以及 2 型糖尿病肾功能衰竭的后续风险

简介 白蛋白尿或估计肾小球滤过率 (eGFR) 的变化可用作 2 型糖尿病患者终末期肾病 (ESKD) 的替代终点。我们调查了蛋白尿和 eGFR 的综合变化是否与未来 ESKD 风险更密切相关。研究设计和方法 使用来自 2 型糖尿病患者的多中心观察性队列研究的数据，我们评估了 2 年内尿白蛋白与肌酐比 (UACR) 的百分比变化和/或 eGFR 的年度变化与随后的 ESKD 风险之间的关联。结果 1417 名重复蛋白尿和 eGFR 超过 2 年的患者中，129 名（9.1%）发展为 ESKD。UACR 下降 >30% 的患者 ESKD 风险较低（HR 0.47；95% CI 0.29 至 0.77），而 UACR 增加 >30% 的患者 ESKD 风险较高（HR 2.31；95% CI 1.52 至 3.51)，与 UACR 变化较小的患者相比。eGFR 下降较大的患者比 eGFR 变化较小（下降 <2.5 mL/min/1.73 m2/年）的患者 ESKD 风险增加：HR 4.19（95% CI 1.87 至 9.38）和 2.89（95% CI 1.32 至6.33) 分别为下降 >5 和 2.5–5 mL/min/1.73 m2/年的那些。当使用 UACR 和 eGFR 的联合变化时，在 UACR 增加 >30% 和 eGFR 下降 >5 mL/min/1.73 m2/的患者中观察到最高的 ESKD 风险（HR 5.60；95% CI 2.08 至 15.09）与那些 UACR 和 eGFR 变化较小的年份相比。结论 2 年内蛋白尿和 eGFR 的综合变化与 2 型糖尿病患者未来发生肾衰竭的风险密切相关。与研究相关的所有数据，