Kidney outcomes and all-cause mortality in people with type 2 diabetes exhibiting non-albuminuric kidney insufficiency,Diabetologia

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Kidney outcomes and all-cause mortality in people with type 2 diabetes exhibiting non-albuminuric kidney insufficiency
Diabetologia ( IF 8.4 ) Pub Date : 2021-11-05 , DOI: 10.1007/s00125-021-05590-5
Yui Yamamoto ₁ , Ko Hanai ₁ , Tomomi Mori ₁ , Yoichi Yokoyama ₁ , Naoshi Yoshida ₁ , Hidekazu Murata ₁ , Tomohiro Shinozaki ₂ , Tetsuya Babazono ₁

Affiliation

Aim/hypothesis

It remains unclear whether people with diabetes exhibiting non-albuminuric kidney insufficiency have higher risk of kidney function decline and mortality compared with those exhibiting preserved kidney function without albuminuria. Furthermore, information regarding the incidence of albuminuria in people with this unique phenotype is sparse. Here, we aimed to elucidate the risk of the kidney outcomes and all-cause mortality in people with diabetes exhibiting non-albuminuric kidney insufficiency.

Methods

In this retrospective cohort study, 8320 Japanese adults with type 2 diabetes were classified into four groups based on the presence of albuminuria and kidney insufficiency at baseline, defined as urinary albumin/creatinine ratio of equal to or above 30 mg/g and eGFR of less than 60 ml min⁻¹ 1.73 m⁻², respectively. The primary composite kidney endpoint was a 50% decrease in eGFR from baseline or the initiation of kidney replacement therapy. The annual percentage change in eGFR slope and progression of albuminuria category were evaluated as the secondary and tertiary kidney endpoints, respectively. All-cause death was also set as the endpoint.

Results

Compared with people exhibiting non-albuminuric preserved kidney function, those with non-albuminuric kidney insufficiency had the higher risk for the primary kidney endpoint (HR 4.1; 95% CI 2.5, 6.7; p < 0.001), steep percentage change in eGFR slope (-1.96%/year vs -1.36%/year, p < 0.001), incidence of albuminuria (HR 2.1; 1.7, 2.6; p < 0.001) and all-cause mortality (HR 1.5; 1.2, 2.0; p = 0.003). In the sensitivity analyses treating the incidence of albuminuria as a competing risk, people with non-albuminuric kidney insufficiency still had higher risk for the primary kidney endpoint and all-cause mortality than those with non-albuminuric preserved kidney function (subdistribution HR 2.8; 1.4, 5.6; p = 0.004; and 1.6; 1.1, 2.2; p = 0.014, respectively).

Conclusions/interpretation

People with type 2 diabetes exhibiting non-albuminuric kidney insufficiency had poorer kidney outcomes and life prognosis than those exhibiting non-albuminuric preserved kidney function.

Graphical abstract

中文翻译：

非白蛋白尿肾功能不全的 2 型糖尿病患者的肾脏结局和全因死亡率

目标/假设

与没有白蛋白尿但肾功能正常的糖尿病患者相比，非白蛋白尿肾功能不全的糖尿病患者肾功能下降和死亡风险是否更高尚不清楚。此外，关于具有这种独特表型的人的蛋白尿发生率的信息很少。在这里，我们旨在阐明非白蛋白尿肾功能不全的糖尿病患者肾脏结局和全因死亡率的风险。

方法

在这项回顾性队列研究中，8320 名患有 2 型糖尿病的日本成年人根据基线时存在白蛋白尿和肾功能不全（定义为尿白蛋白/肌酐比等于或高于 30 mg/g 和 eGFR 低于分别大于 60 ml min ^-1 1.73 m ^-2。主要的复合肾脏终点是 eGFR 较基线下降 50% 或开始肾脏替代治疗。eGFR 斜率的年度百分比变化和白蛋白尿类别的进展分别被评估为二级和三级肾脏终点。全因死亡也被设定为终点。

结果

与表现出非白蛋白尿保留肾功能的人相比，非白蛋白尿肾功能不全患者的主要肾脏终点风险更高（HR 4.1；95% CI 2.5, 6.7；p < 0.001），eGFR 斜率的百分比变化陡峭（ -1.96%/年 vs -1.36%/年，p < 0.001)，蛋白尿发生率 (HR 2.1; 1.7, 2.6; p < 0.001) 和全因死亡率 (HR 1.5; 1.2, 2.0; p = 0.003)。在将白蛋白尿的发生率视为竞争风险的敏感性分析中，非白蛋白尿肾功能不全患者的主要肾脏终点和全因死亡率的风险仍然高于非白蛋白尿保留肾功能的患者（子分布 HR 2.8；1.4 , 5.6; p = 0.004; 和 1.6；1.1、2.2；p = 0.014，分别）。