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Kidney Function Decline Faster in Diabetes

Kidney function decline tends to be more rapid among diabetes patients vs patients without diabetes, according to a new study. 

Reference: Warren B, Rebholz CM, Sang Y, et al. Diabetes and trajectories of estimated glomerular filtration rate: A prospective cohort analysis of the atherosclerosis risk in communities study. Diabetes Care. 2018;41:1646:1653.

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Bethany Warren and colleagues at Johns Hopkins University in Baltimore found that diabetes (DM) patients had a much more rapid decline in kidney function vs people without DM and that certain risk factors are associated with the rate of decline. Click through the slides above for study details and take home points for physicians.

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Diabetes and Kidney Function. The authors of the study aimed to identify in DM patients the demographic, genetic, and modifiable risk factors associated with steeper eGFR decline. 

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The Study. Authors of the study classified 15 517 participants in the community-based Atherosclerosis Risk in Communities study by diabetes status:

  • No DM: 88%
  • Undiagnosed DM: 4%
  • Diagnosed DM: 8%
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Results. There was a nearly linear associated between eGFR and age over time, regardless of DM status. Also, the mean annual eGFR decline was slowest among those without DM, faster among undiagnosed DM vs without DM, and twice as rapid among diagnosed DM vs without DM. 

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Results (cont'd). For those with baseline DM, risk factors for steeper annual eGFR decline include:

  • African American race
  • Systolic BP ≥140 mmHg
  • On DM medications
  • A1c ≥7%
  • 1,5-AG <10 mg/mL
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Take Home Points:

  • DM is an important risk factor for kidney function decline and physicians should educate patients accordingly.
  • In patients with undiagnosed DM, an early period of hyperfiltration may precede eGFR decline.
  • Among persons with DM, eGFR decline is highly variable and linked to race, high BP, and glycemia. 
  • Strongly encourage and promote glycemic and BP control among DM patients to mitigate CV risk and a steeper trajectory for kidney function decline.
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