RT Journal Article
SR Electronic
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
FD American Diabetes Association
SP e002241
DO 10.1136/bmjdrc-2021-002241
VO 9
IS 1
A1 Masayuki Yamanouchi
A1 Kengo Furuichi
A1 Junichi Hoshino
A1 Tadashi Toyama
A1 Miho Shimizu
A1 Yuta Yamamura
A1 Megumi Oshima
A1 Shinji Kitajima
A1 Akinori Hara
A1 Yasunori Iwata
A1 Norihiko Sakai
A1 Yuki Oba
A1 Shusaku Matsuoka
A1 Daisuke Ikuma
A1 Hiroki Mizuno
A1 Tatsuya Suwabe
A1 Naoki Sawa
A1 Yukio Yuzawa
A1 Hiroshi Kitamura
A1 Yoshiki Suzuki
A1 Hiroshi Sato
A1 Noriko Uesugi
A1 Yoshihiko Ueda
A1 Shinichi Nishi
A1 Hitoshi Yokoyama
A1 Tomoya Nishino
A1 Kenichi Samejima
A1 Kentaro Kohagura
A1 Yugo Shibagaki
A1 Hirofumi Makino
A1 Seiichi Matsuo
A1 Yoshifumi Ubara
A1 Takashi Wada
A1 ,
YR 2021
UL http://drc.bmj.com/content/9/1/e002241.abstract
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 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.