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Adults from the African Caribbean and those with high HbA1c levels are more likely to have a nonlinear decline in kidney function, which increases the progression of end-stage kidney disease in type 2 diabetes, according to study data.
“We studied an ethnically diverse cohort, with nearly half of our patients being of African Caribbean origin and at a higher risk of developing ESRD compared to other races,” said Stanimir I. Stoilov, BSc, former research intern at Guy’s and St. Thomas. NHS Foundation Trust and a graduate medical degree from the University of Warwick, UK, as well as colleagues wrote in a study published in the Journal of Diabetes and Its Complications. “Our observation that patients with diabetic kidney disease in the Caribbean are more likely to follow a non-linear, accelerating estimated glomerular filtration rate in the Caribbean is consistent with the results of the ASSK (African American Study of Kidney Disease and Hypertension), which included no patients with kidney disease participated in diabetes but observed that nonlinear trajectories were more common in this ethnic group. “
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The researchers analyzed electronic health record data from 398 people with type 2 diabetes and diabetic kidney disease with a baseline eGFR of 30 ml / min / 1.73 m2 or more who attended a single center from 2004 to 2018. Demographics, diabetes and comorbidity, drug intake data on biochemistry, blood pressure, and anthropometry were collected. A generalized additive model was used to determine the linearity of eGFR.
Of the study population, 46.5% were from the African Caribbean, and more than 90% had elevated levels of albuminuria and documented diabetic retinopathy. ESRD occurred in 71 of the 398 participants during a mean follow-up period of 7 years.
Of those who had ESRD, 29 had a linear trajectory of eGFR decline and 42 had a nonlinear trajectory. Those with a nonlinear trajectory were further divided into three categories: an accelerator trajectory with a stable decrease in renal function loss, followed by an accelerated eGFR decrease (n = 16), a deceleration trajectory with a stable decrease, followed by a decrease in eGFR decrease ( n = 9) and a gradual trajectory with no clear pattern or where eGFR dropped and rose unpredictably (n = 17).
Participants from the African Caribbean had significantly higher chances of accelerating the eGFR decline regardless of traditional risk factors including BP, eGFR and baseline albuminuria (OR = 10.6; 95% CI, 2.14-52.7; P. <0.001). Adults with a higher HbA1c had an increased likelihood of a gradual eGFR trajectory (OR = 1.15; 95% CI, 1.03-1.3; P = 0.02).
‘These results are a guide for future work that should focus on defining robust methods of predicting eGFR decline based on early trajectories and associated risk factors, in order to provide personalized attention to those at greatest risk there is rapid progression to ESRD, “the researchers write.
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