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Abstract: TH-PO167

Trajectory of Glomerular Filtration Rate Decline and Fluctuation in Albuminuria Leading to ESKD: An Observational Cohort Study of Biopsy-Confirmed Diabetic Kidney Disease

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical


  • Yamanouchi, Masayuki, Toranomon Byoin, Minato-ku, Tokyo, Japan

Data on trajectory of kidney function decline and fluctuation in albuminuria leading to end-stage kidney disease (ESKD) is sparse in patients with type 2 diabetes.


Using data from an observational study of biopsy-confirmed diabetic kidney disease (DKD), panel data analyses were performed to quantify patterns of trajectory of estimated glomerular filtration rate (eGFR) decline to ESKD associated with repeated measures of urine albumin-to-creatinine ratio (ACR).


During a median follow-up of 3.25 years, 156 out of 312 developed ESKD. Among them, 84.0% showed a curvilinear pattern of eGFR trajectory, 62.2% moved into a different albuminuria status from that at baseline, and 84.6% of patients developed nephrotic-range albuminuria, many of whom remained nephrotic. Mixed-effects models for repeated measures showed that speed of eGFR decline for normo- [ACR <30 mg/g], micro- [ACR 30 to <300 mg/g], macro- (non-nephrotic range albuminuria) [ACR 300 to <3000 mg/g] and nephrotic-range albuminuria [ACR ≥3000 mg/g] were -2.50 (95% CI, -8.62 to 3.62; P =0.423), -4.76 (95% CI, -8.94 to -0.57; P =0.026), -6.39 (95% CI, -8.31 to -4.48; P <0.001) and -9.51 (95% CI, -11.75 to -7.28; P <0.001) mL/min/1.73 m2/year, respectively.


Majority of patients with biopsy-confirmed DKD who developed ESKD showed a curvilinear eGFR trajectory with fluctuation in ACR. Although there were high inter- and intra-individual variability in changes in eGFR and ACR, ACR were inversely associated with eGFR decline, which suggests that close monitoring of ACR fluctuation over time instead of a single assessment of ACR may be necessary to detect eGFR decline to ESKD.