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Abstract
Objective Variability in estimated glomerular filtration rate (eGFR) has been associated with adverse outcomes in patients with diabetes or chronic kidney disease (CKD). However, no previous study has explored the relationship between eGFR variability and type 2 diabetes incidence.
Research design and methods In this nationwide, longitudinal, cohort study, we investigated the association between eGFR variability and type 2 diabetes risk using the Korean National Health Insurance Service datasets from 2002 to 2017. eGFR variability was calculated using the variability independent of the mean (eGFR-VIM), coefficient of variation (eGFR-CV), standard deviation (eGFR-SD) and average real variability (eGFR-ARV).
Results Within 7 673 905.58 person-years of follow-up (mean follow-up: 3.19 years; n=2 402 668), 11 981 cases of incident type 2 diabetes were reported. The HRs and 95% CIs for incident type 2 diabetes increased according to advance in quartiles of eGFR-VIM (HR (95% CI): Q2, 1.068 (1.009 to 1.130); Q3, 1.077 (1.018 to 1.138); Q4, 1.203 (1.139 to 1.270)) even after adjusting for confounding factors including mean eGFR and mean fasting plasma glucose levels. The subgroup analyses according to risk factors as well as analyses using eGFR-CV, eGFR-SD and eGFR-ARV showed consistent results. The association between increased eGFR variability and type 2 diabetes risk was more prominent in men, individuals with dyslipidemia and those with CKD as shown in the subgroup analysis (p for interaction <0.001).
Conclusions Increased eGFR variability may be an independent predictor of type 2 diabetes and might be useful for risk stratification of individuals without diabetes.
- GFR
- chronic kidney disease
- type 2 diabetes
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Footnotes
KH and KMC contributed equally.
Contributors Y-BL drafted the manuscript. Y-BL, KH, JAK and KMC contributed to the study design. KH and DHK participated in the data analysis planning and KH participated in statistical analysis. ER, S-HH, HJY and SHB searched for related literature and contributed to the hypothesis conception. KMC critically edited the manuscript. All authors contributed important intellectual content during manuscript drafting or revision and approved the final version of the manuscript. KMC is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This work was funded by the Korea University Research Fund to KMC. The corresponding author had full access to the data and final responsibility for the decision to submit for publication.
Disclaimer The funder had no role in the study design; data collection, analysis and interpretation or writing of the report.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Institutional Review Board (IRB) of Korea University (IRB file number: 2019GR0200). An informed consent exemption was granted by the IRB because the KNHIS provided the researchers with only anonymous, de-identified data.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Korean National Health Insurance Service (KNHIS) but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. On an individual basis, data are however available from the authors on reasonable request and with permission from the KNHIS. Additional study-related documents and de-identified data may be requested by written application to the corresponding author.