TY - JOUR
T1 - Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death
T2 - A nationwide cohort study of biopsy-proven diabetic kidney disease
AU - Yamanouchi, Masayuki
AU - Furuichi, Kengo
AU - Hoshino, Junichi
AU - Toyama, Tadashi
AU - Shimizu, Miho
AU - Yamamura, Yuta
AU - Oshima, Megumi
AU - Kitajima, Shinji
AU - Hara, Akinori
AU - Iwata, Yasunori
AU - Sakai, Norihiko
AU - Oba, Yuki
AU - Matsuoka, Shusaku
AU - Ikuma, Daisuke
AU - Mizuno, Hiroki
AU - Suwabe, Tatsuya
AU - Sawa, Naoki
AU - Yuzawa, Yukio
AU - Kitamura, Hiroshi
AU - Suzuki, Yoshiki
AU - Sato, Hiroshi
AU - Uesugi, Noriko
AU - Ueda, Yoshihiko
AU - Nishi, Shinichi
AU - Yokoyama, Hitoshi
AU - Nishino, Tomoya
AU - Samejima, Kenichi
AU - Kohagura, Kentaro
AU - Shibagaki, Yugo
AU - Makino, Hirofumi
AU - Matsuo, Seiichi
AU - Ubara, Yoshifumi
AU - Wada, Takashi
N1 - Funding Information:
We used data from a nationwide DKD study, supported by the Ministry of Health, Labour and Welfare of Japan and the Japan Agency for Medical Research and Development. The rationale and study designs are available elsewhere.22 23 In brief, the study is an observational, retrospective, kidney biopsy-based cohort study of 895 patients with type 2 diabetes aged 30–82 years who underwent clinical kidney biopsy between 1985 and 2016 at 18 hospitals across Japan. The study population had a pathological diagnosis, with DKD as the only kidney disease diagnosis. The majority of study population were under the care of each hospital or its satellite clinics every 3 months and were followed up from the date of biopsy until the earliest date of (1) ESKD (defined as initiation of hemodialysis, peritoneal dialysis, pre-emptive kidney transplantation, or death from uremia); (2) all-cause death before ESKD; or (3) censoring (censoring for loss to follow-up or administrative censoring occurring at the end of December 2019).
Funding Information:
Funding This study was supported in part by the Ministry of Health, Labour and Welfare Grant-in-Aid for Diabetic Nephropathy and Nephrosclerosis Research (JP17ek0310003) and a grant for medical research from the Okinaka Memorial Institute for Medical Research, Tokyo, Japan (20201-18).
Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/8/12
Y1 - 2021/8/12
N2 - 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 m 2 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: a € high-increasing' group (n=254; 77.2%), a € high-decreasing' group (n=24; 7.3%), and a € low-stable' group (n=51; 15.5%). The a € low-stable' group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): a € low-stable', 109 (50-138); a € high-decreasing', 906 (468-1740); a € 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 a € high-decreasing' group and the a € high-increasing' group, the a € 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 a € high-decreasing' group compared with the a € 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.
AB - 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 m 2 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: a € high-increasing' group (n=254; 77.2%), a € high-decreasing' group (n=24; 7.3%), and a € low-stable' group (n=51; 15.5%). The a € low-stable' group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): a € low-stable', 109 (50-138); a € high-decreasing', 906 (468-1740); a € 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 a € high-decreasing' group and the a € high-increasing' group, the a € 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 a € high-decreasing' group compared with the a € 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.
KW - albuminuria
KW - chronic
KW - kidney failure
KW - longitudinal studies
KW - mortality
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U2 - 10.1136/bmjdrc-2021-002241
DO - 10.1136/bmjdrc-2021-002241
M3 - Article
C2 - 34385147
AN - SCOPUS:85113245949
SN - 2052-4897
VL - 9
JO - BMJ Open Diabetes Research and Care
JF - BMJ Open Diabetes Research and Care
IS - 1
M1 - e002241
ER -
