Abstract: SA-PO170
Younger Age, Afro-Caribbean Ethnicity, and Residual Albuminuria Predict Renal Function Decline in Patients with Diabetic Kidney Disease on Renin Angiotensin System Blockade
Session Information
- Diabetic Kidney Disease: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Fountoulakis, Nikolaos, King's College London, London, United Kingdom
- Gnudi, Luigi, King's College London, London, United Kingdom
- Karalliedde, Janaka J., King''s College London, Kent, United Kingdom
Background
There is heterogeneity in the progression of renal function decline in diabetic kidney disease (DKD). The clinical markers and patient features that predict loss of renal function in DKD despite renin angiotensin system (RAS) treament remain unclear.
Methods
In a single centre study we studied 266 (n=50 Type 1 and n=216 Type 2) patients with DKD on RAS blockade. All patients had baseline estimated glomerular filtration rate (eGFR) by Modification of Diet in Renal Disease Study equation >45 ml/min.
Patients were followed up for a median 10 years with standardised clinical care measures.
Primary endpoint was progression of DKD defined as eGFR fall >5ml/min/year or end stage renal disease (ESRD-dialysis or transplantation). In a cause specific Cox proportional hazards model predictors of ESRD were also evaluated with death from any cause as competing event.
Results
In the T1DM cohort patients with progression (n=13) as compared to those without (n=37), In multivariate analyses [odds ratio (OR) and 95% confidence intervals (CI)] duration of diabetes OR 0.74 (0.56 - 0.99), baseline eGFR 1.09 (1.01 to 1.17) and ACR 9.5 (1.35- 66.7) were independent predictors of progression, p<0.05 for all.
Similarly for T2DM cohort (n=216, 62% male, 40% Afro-Caribbean), 20% (n=50) had progression. Baseline eGFR, OR (95%CI), 1.04 (1.02 to 1.06) and ACR 1.4 (1.05- 1.9) were independent predictors of progression,p<0.05 for all. In T2DM 44 patients developed ESRD, these patients as compared to those without ESRD (n=172) were younger (57.3 ± 10.5 vs. 62 ± 10.4 years), more likely to be Afro-Caribbean (87% vs. 34%) with higher ACR [30.0 (12.7 - 30.0) vs. 9.1 (2.0 - 30.0) mg/mmol],p<0.05 for all. In cause specific competing risk analyses, hazard ratio (95% CI), age 0.94 (0.91 - 0.98), Afro-Caribbean ethnicity 2.30 (1.07 - 4.90), and ACR 1.53 (1.08 - 2.16) were independent predictors of ESRD, p<0.05 for all.
Conclusion
In DKD residual albuminuria despite RAS blockade increased risk of significant renal function decline. In T2DM younger age, residual albuminuria and Afro-Caribbean ethnicity increase risk of ESRD. Treatments that reduce residual albuminuria despite RAS may help reduce progression of DKD.