%0 Journal Article %A Megumi Oshima %A Tadashi Toyama %A Akinori Hara %A Miho Shimizu %A Shinji Kitajima %A Yasunori Iwata %A Norihiko Sakai %A Kengo Furuichi %A Masakazu Haneda %A Tetsuya Babazono %A Hiroki Yokoyama %A Kunitoshi Iseki %A Shin-ichi Araki %A Toshiharu Ninomiya %A Shigeko Hara %A Yoshiki Suzuki %A Masayuki Iwano %A Eiji Kusano %A Tatsumi Moriya %A Hiroaki Satoh %A Hiroyuki Nakamura %A Hirofumi Makino %A Takashi Wada %T Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes %D 2021 %R 10.1136/bmjdrc-2021-002311 %J BMJ Open Diabetes Research & Care %P e002311 %V 9 %N 1 %X Introduction Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD.Research design and methods Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk.Results Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m2/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5–5 mL/min/1.73 m2/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m2/year compared with those with a minor change in UACR and eGFR.Conclusions Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.All data relevant to the study, details of the study protocol and statistical analysis plan will be available on reasonable request. %U https://drc.bmj.com/content/bmjdrc/9/1/e002311.full.pdf