Author(s): Pavkov ME, Knowler WC, Lemley KV, Mason CC, Myers BD,
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Abstract BACKGROUND AND OBJECTIVES: Early decline in GFR may reflect progressive kidney disease in type 1 diabetes, but its predictive value in type 2 diabetes is uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this longitudinal study, GFR was measured serially over approximately 4.0 years in 195 Pima Indians with type 2 diabetes. Renal function decline (RFD) was defined during this initial period by an average GFR loss ≥3.3\%/yr, as defined previously in type 1 diabetes. Subsequently, participants were followed for up to 17.8 years to ESRD onset, death, or December 31, 2010, whichever came first. RESULTS: RFD prevalence during the initial period was 32\% in 68 participants with normal baseline albuminuria (albumin/creatinine ratio [ACR] < 30 mg/g), 42\% in 88 with microalbuminuria (ACR 30 to <300 mg/g), and 74\% in 39 with macroalbuminuria (ACR ≥300 mg/g; P<0.001). The cumulative incidence of ESRD 10 years after the initial period was 41\% in those with RFD and 15\% in those without (P<0.001); 41 of the 49 ESRD cases (83.7\%) occurred in participants who had or developed macroalbuminuria during the initial period. When adjusted for age, sex, diabetes duration, and hemoglobin A1c, the ESRD hazard rate was 4.78 times (95\% confidence interval, 2.39-9.58) as high in those with RFD as in those without; further adjustment for albuminuria attenuated this association (hazard ratio, 1.79; 95\% confidence interval, 0.82-3.91). CONCLUSIONS: In type 2 diabetes, loss of GFR often occurs before the onset of macroalbuminuria, but a decline predictive of ESRD is strongly dependent on progression to macroalbuminuria.
This article was published in Clin J Am Soc Nephrol
and referenced in Journal of Diabetes & Metabolism