TY - JOUR T1 - 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 JF - BMJ Open Diabetes Research & Care JO - BMJ Open Diab Res Care DO - 10.1136/bmjdrc-2021-002241 VL - 9 IS - 1 SP - e002241 AU - Masayuki Yamanouchi AU - Kengo Furuichi AU - Junichi Hoshino AU - Tadashi Toyama AU - Miho Shimizu AU - Yuta Yamamura AU - Megumi Oshima AU - Shinji Kitajima AU - Akinori Hara AU - Yasunori Iwata AU - Norihiko Sakai AU - Yuki Oba AU - Shusaku Matsuoka AU - Daisuke Ikuma AU - Hiroki Mizuno AU - Tatsuya Suwabe AU - Naoki Sawa AU - Yukio Yuzawa AU - Hiroshi Kitamura AU - Yoshiki Suzuki AU - Hiroshi Sato AU - Noriko Uesugi AU - Yoshihiko Ueda AU - Shinichi Nishi AU - Hitoshi Yokoyama AU - Tomoya Nishino AU - Kenichi Samejima AU - Kentaro Kohagura AU - Yugo Shibagaki AU - Hirofumi Makino AU - Seiichi Matsuo AU - Yoshifumi Ubara AU - Takashi Wada A2 - , Y1 - 2021/08/01 UR - http://drc.bmj.com/content/9/1/e002241.abstract 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 m2 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: ‘high-increasing’ group (n=254; 77.2%), ‘high-decreasing’ group (n=24; 7.3%), and ‘low-stable’ group (n=51; 15.5%). The ‘low-stable’ group had the most favorable risk profile, including the baseline UACR (median (IQR) UACR (mg/g creatinine): ‘low-stable’, 109 (50–138); ‘high-decreasing’, 906 (468–1740); ‘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 ‘high-decreasing’ group and the ‘high-increasing’ group, the ‘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 ‘high-decreasing’ group compared with the ‘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.The inspection and usage of the raw data in this study is restricted according to the ethical approval. All data relevant to the study are included in the article or uploaded as online supplemental material. ER -