Development in eGFR Trajectories in People With Diabetic Nephropathy

Christina Gjerlev Poulsen*, Kristin Jesse, Bendix Carstensen, Marie Frimodt-Møller, Tine Willum Hansen, Dorte Vistisen, Peter Rossing, Frederik Persson

*Corresponding author for this work

Abstract

BACKGROUND
Diabetic nephropathy (DN) is a frequent and serious complication to type 1 diabetes (T1D) and type 2 diabetes (T2D). The effect of advancing diabetes care over the past decades on progression in DN requires update. We analyzed the development over calendar time in eGFR trajectories from time of DN diagnosis.

METHODS
Retrospective cohort study, with data collected from electronic health records from persons attending the outpatient clinic at Steno Diabetes Center Copenhagen, Denmark between 2001-2020. Inclusion criteria were: T1D/T2D and DN, defined as urine albumin to creatinine ratio > 300 mg/g or urine albumin excretion rate > 300 mg/24h in two occasions > 60 days apart. Individual eGFR trajectories were calculated separately for T1D and T2D, using mixed-effects models with fixed effects of age and interactions of splines of DN duration and date of diagnosis.

RESULTS
The T1D cohort included 888 persons, 59.7% male and median (IQR) age at DN diagnosis was 50 (38-62) years. Figure 1A shows estimated trajectories for eGFR for a person with T1D diagnosed with DN at age 50 in 2000, 2005, 2010 or 2015. eGFR at time of DN diagnosis increased with 1.8 ml/min/1.73m2/year. Improvement in eGFR trajectories with calendar time was not evident, but with a tendency toward attenuating decline after 2010.
The T2D cohort included 1480 persons, 71.9% male and median (IQR) age at DN diagnosis was 65 (58-72) years. Figure 1B shows estimated trajectories for eGFR for a person with T2D diagnosed with DN at age 65 in 2000, 2005, 2010 or 2015. eGFR at time of DN diagnosis increased with 0.7 ml/min/1.73m2/year. Most pronounced increase was between 2000 and 2005. The eGFR trajectories for T2D were similar across calendar time.

CONCLUSION
Kidney function at time of DN diagnoses has increased over the past 20 years, most pronounced in T1D, where eGFR decline appears attenuating in most recent years. This may be explained by improved awareness and treatment.
Original languageEnglish
Publication date2022
Publication statusPublished - 2022
EventASN Kidney Week 2022 - Orlando, United States
Duration: 2 Nov 20226 Nov 2022

Conference

ConferenceASN Kidney Week 2022
Country/TerritoryUnited States
CityOrlando
Period02/11/202206/11/2022

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