Two-year longitudinal trajectory patterns of albuminuria and subsequent rates of end-stage kidney disease and all-cause death: A nationwide cohort study of biopsy-proven diabetic kidney disease

Masayuki Yamanouchi, Kengo Furuichi, Junichi Hoshino, Tadashi Toyama, Miho Shimizu, Yuta Yamamura, Megumi Oshima, Shinji Kitajima, Akinori Hara, Yasunori Iwata, Norihiko Sakai, Yuki Oba, Shusaku Matsuoka, Daisuke Ikuma, Hiroki Mizuno, Tatsuya Suwabe, Naoki Sawa, Yukio Yuzawa, Hiroshi Kitamura, Yoshiki SuzukiHiroshi Sato, Noriko Uesugi, Yoshihiko Ueda, Shinichi Nishi, Hitoshi Yokoyama, Tomoya Nishino, Kenichi Samejima, Kentaro Kohagura, Yugo Shibagaki, Hirofumi Makino, Seiichi Matsuo, Yoshifumi Ubara, Takashi Wada

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Abstract

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.

Original languageEnglish
Article numbere002241
JournalBMJ Open Diabetes Research and Care
Volume9
Issue number1
DOIs
Publication statusPublished - Aug 12 2021

Keywords

  • albuminuria
  • chronic
  • kidney failure
  • longitudinal studies
  • mortality

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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