Abstract: FR-PO480

eGFR Trajectories and Risks of Death and Cardiovascular Events in Adults with Type 2 Diabetes

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Daratha, Kenn B., Providence Health Services, Spokane, Washington, United States
  • McPherson, Sterling, Providence Health Services, Spokane, Washington, United States
  • Dieter, Brad, Providence Health Services, Spokane, Washington, United States
  • Alicic, Radica Z., Providence Health Services, Spokane, Washington, United States
  • Tuttle, Katherine R., Providence Health Services, Spokane, Washington, United States
Background

Diabetes is the most common cause of chronic kidney disease (CKD) worldwide. Most with diabetes and CKD will experience death or a cardiovascular disease (CVD) event before reaching end-stage kidney disease. Decline in estimated glomerular filtration rate (eGFR) may be an antecedent of such events. The aim of this study was to determine the relationship of eGFR decline with death and CVD events among persons with type 2 diabetes.

Methods

The ACCORD trial tested intensive control of glycemia in adults with type 2 diabetes. In our study, group-based modeling classified eGFR trajectories of 10052/10251 (98%) ACCORD participants with at least 2 eGFR (CKD-EPI) measurements. Trajectory classification was based on greatest likelihood an individual trajectory fit within a hypothesized class structure (both in number and classes and order of each function). Cox proportional hazards models examined risk of the primary ACCORD outcome (CVD death, myocardial infarction, stroke) by eGFR trajectory assignment.

Results

Participants were followed up to 7 years. Baseline characteristics included: age 62.7+6.6 (mean+SD) years; women 38% (3857/10052); White race 62% (6281/10052); diabetes duration 10.7+7.6 years; HbA1c 8.3+1.1 %; eGFR 84.0+17.5 mL/min/1.73m2; and urine albumin-to-creatinine ratio 13, 6-43 (median, IQR).

Approximately 10% (1027/10052) of participants were classified in the lowest trajectory class with eGFR values persistently <60 mL/min/1.73m2. In the next trajectory class, 21% (2101/10052) were classified with initial eGFR values above, but falling below, 60 mL/min/1.73m2 over time. Three additional classes were defined with eGFR above 60 mL/min/1.73m2 throughout the study. Fully-adjusted models controlled for baseline eGFR (isolating the independent effect of the trajectory slope), age, sex, race, diabetes duration, HbA1c, albuminuria, and treatment. Hazards for the primary outcome were greater for the two lowest compared to the highest eGFR trajectory class (HR1=1.52; 95%CI=1.07-2.18; p=0.03 and HR2=1.42; 95%CI=1.06-1.90; p=0.02).

Conclusion

More rapid eGFR decline in persons with type 2 diabetes independently predicted significantly greater risk of death and CVD events.