Introduction Data on the association between longitudinal trajectory patterns of albuminuria and subsequent end-stage kidney disease (ESKD) and all-cause mortality in diabetic kidney disease (DKD) are sparse. Research design and methods Drawing on nationally representative data of 329 patients with biopsy-proven DKD and an estimated glomerular filtration rate above 30 mL/min/1.73 m2 at the time of biopsy, we used joint latent class mixed models to identify different 2-year trajectory patterns of urine albumin to creatinine ratio (UACR) and assessed subsequent rates of competing events: ESKD and all-cause death. Results A total of three trajectory groups of UACR were identified: ‘high-increasing’ group (n=254; 77.2%), ‘high-decreasing’ group (n=24; 7.3%), and ‘low-stable’ group (n=51; 15.5%). The ‘low-stable’ group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): ‘low-stable’, 109 (50–138); ‘high-decreasing’, 906 (468–1740); ‘high-increasing’, 1380 (654–2502)), and had the least subsequent risk of ESKD and all-cause death among the groups. Although there were no differences in baseline characteristics between the ‘high-decreasing’ group and the ‘high-increasing’ group, the ‘high-decreasing’ group had better control over blood pressure, blood glucose, and total cholesterol levels during the first 2 years of follow-up, and the incidence rates of subsequent ESKD and all-cause death were lower in the ‘high-decreasing’ group compared with the ‘high-increasing’ group (incidence rate of ESKD (per 1000 person-years): 32.7 vs 77.4, p=0.014; incidence rate of all-cause death (per 1000 person-years): 0.0 vs 25.4, p=0.007). Conclusions Dynamic changes in albuminuria are associated with subsequent ESKD and all-cause mortality in DKD. Reduction in albuminuria by improving risk profile may decrease the risk of ESKD and all-cause death. The inspection and usage of the raw data in this study is restricted according to the ethical approval. All data relevant to the study are included in the article or uploaded as online supplemental material.

中文翻译：

---

白蛋白尿的两年纵向轨迹模式以及随后的终末期肾病和全因死亡率：一项针对活检证实的糖尿病肾病的全国性队列研究

介绍 白蛋白尿的纵向轨迹模式与随后的终末期肾病 (ESKD) 和糖尿病肾病 (DKD) 的全因死亡率之间关联的数据很少。研究设计和方法 利用 329 名活检证实的 DKD 患者的全国代表性数据，活检时估计肾小球滤过率高于 30 mL/min/1.73 m2，我们使用联合潜类混合模型来识别不同的 2 年尿白蛋白与肌酐比值 (UACR) 的轨迹模式并评估随后的竞争事件发生率：ESKD 和全因死亡。结果 总共确定了三个 UACR 轨迹组：“高增加”组（n=254；77.2%）、“高减少”组（n=24；7.3%）和“低稳定”组（ n=51；15.5%）。“低稳定”组具有最有利的风险特征，包括基线 UACR（中值 (IQR) UACR（mg/g 肌酐）：“低稳定”，109 (50–138)；“高下降”， 906 (468–1740)；“高增长”，1380 (654–2502))，并且在各组中随后发生 ESKD 和全因死亡的风险最小。虽然“高降”组和“高升”组的基线特征没有差异，但“高降”组在前2年对血压、血糖和总胆固醇水平的控制更好“高下降”组与“高下降”组相比，后续ESKD发生率和全因死亡发生率较低（ESKD发生率（每1000人年））： 32.7 对 77.4，p=0.014；全因死亡的发生率（每 1000 人年）：0.0 对 25.4，p=0.007）。结论 白蛋白尿的动态变化与随后的 ESKD 和 DKD 的全因死亡率相关。通过改善风险状况来减少蛋白尿可能会降低 ESKD 和全因死亡的风险。本研究中原始数据的检查和使用受到伦理批准的限制。与研究相关的所有数据都包含在文章中或作为在线补充材料上传。