Development in eGFR trajectories in people with diabetic nephropathy

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

*Corresponding author for this work

Abstract

Background and aims: Diabetic nephropathy (DN) is a frequent and serious complication to both type 1 diabetes (T1D) and type 2 diabetes (T2D) and is characterized by a progressive loss of kidney function, elevated blood pressure and increased risk of cardiovascular disease and death. The effect of advancing diabetes care over the past decades on progression and prognosis for persons diagnosed with DN requires updating. In this study we analyzed the development over calendar time in eGFR trajectories from the time of DN diagnosis.

Materials and methods: In a retrospective cohort study, data was 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 (UACR) > 300mg/g or urine albumin excretion rate (UAER) > 300 mg/24hours in two separate measurements > 60 days apart. Individual eGFR trajectories were calculated separately for T1D and T2D, using mixed-effects models with fixed effects of age, sex, date of DN diagnosis, duration of DN, and random effects of person and duration of DN.

Results: The T1D cohort included 891 persons, 59.7% were male and median (IQR) age at DN diagnosis was 50 (38-62) years. Figure 1A shows the estimated trajectories for eGFR for a person diagnosed with T1D and DN at age 50 in 2000, 2005, 2010 and 2015. eGFR at the time of DN diagnosis increased over time with 1.8 ml/min/1.73m2 per calendar year. The T2D cohort included 1447 persons, 71.9% were male and median (IQR) age at DN diagnosis was 65 (58-72) years. Figure 1B shows the estimated trajectories for eGFR for a person diagnosed with DN at age 65 in 2000, 2005, 2010 and 2015. eGFR at the time of DN diagnosis increased with 0.7 ml/min/1.73m2 per calendar year. For both T1D and T2D, the trajectories depict a tendency towards an attenuating decline in eGFR over time, when diagnosed with DN in more recent years, but with a faster decline in the first five years after diagnosis of DN.

Conclusion: Kidney function at time of DN diagnoses has increased over the past 20 years, especially in T1D. Moreover, the eGFR decline after diagnosis seems attenuating when diagnosed in more recent years. This may be explained by improved awareness and treatment.
Original languageEnglish
JournalDiabetologia
Volume65
Issue numberSuppl 1
ISSN0012-186X
DOIs
Publication statusPublished - Sept 2022
Event58th EASD Annual Meeting of the European Association for the Study of Diabetes - Stockholm, Sweden
Duration: 19 Sept 202223 Sept 2022

Conference

Conference58th EASD Annual Meeting of the European Association for the Study of Diabetes
Country/TerritorySweden
CityStockholm
Period19/09/202223/09/2022

Keywords

  • Diabetes Mellitus
  • Humans
  • Sweden

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