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. 2019 Aug;21(8):1817-1823.
doi: 10.1111/dom.13734. Epub 2019 May 6.

Temporal variation of renal function in people with type 2 diabetes mellitus: A retrospective UK clinical practice research datalink cohort study

Dionysis Spanopoulos  1 , Hajra Okhai  2 , Francesco Zaccardi  2 , Abigail Tebboth  1 , Brendan Barrett  3 , Michael Busse  3 , Joanne Webb  4 , Kamlesh Khunti  2
Affiliations

Temporal variation of renal function in people with type 2 diabetes mellitus: A retrospective UK clinical practice research datalink cohort study

Dionysis Spanopoulos et al. Diabetes Obes Metab. 2019 Aug.

Abstract

Aim: To characterize the longitudinal variability of estimated glomerular filtration rate (eGFR) in people with type 2 diabetes mellitus (T2DM), including variation between categories and individuals.

Methods: People with T2DM and sufficient recorded serum creatinine measurements were identified from the Clinical Practice Research Datalink (T2DM diagnosis from 1 January 2009 to 1 January 2011 with 5 years follow-up); eGFR was calculated using the CKD-EPI equation.

Results: In total, 7766 individuals were included; 32.8%, 50.2%, 12.4%, 4.0% and 0.6% were in glomerular filtration rate (GFR) categories G1, G2, G3a, G3b and G4, respectively. Overall, eGFR decreased by 0.44 mL/min/1.73 m2 per year; eGFR increased by 0.80 mL/min/1.73 m2 between index and year 1, then decreased by 0.75 mL/min/1.73 m2 annually up to year 5. Category G1 showed a steady decline in eGFR over time; G2, G3a and G3b showed an increase between index and year 1, followed by a decline. Category G4 showed a mean eGFR increase of 1.85 mL/min/1.73 m2 annually. People in categories G3-G4 moved across a greater number of GFR categories than those in G1 and G2. Individual patients' eGFR showed a wide range of values (change from baseline at year 5 varied from -80 to +59 mL/min/1.73 m2 ).

Conclusion: Overall, eGFR declined over time, although there was considerable variation between GFR categories and individuals. This highlights the difficulty in prescribing many glucose-lowering therapies, which require dose adjustment for renal function. The study also emphasizes the importance of regular monitoring of renal impairment in people with T2DM.

Keywords: UK; primary care; renal impairment; type 2 diabetes.

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Conflict of interest statement

A.T. and M.B. are employees of Boehringer Ingelheim, the study sponsor. D.S. and B.B. were also employees of Boehringer Ingelheim at the time the study was conducted. J.W. is an employee of Eli Lilly and Company. H.O. and F.Z. received funding from the study sponsors for the analysis and conduct of the study. K.K. has acted as a consultant and or speaker for Napp, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly and Merck Sharp & Dohme, and has received grants in support of investigator and investigator‐initiated trials from Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme.

Figures

Figure 1
Figure 1
Overall estimated glomerular filtration rate (eGFR) trend
Figure 2
Figure 2
Estimated glomerular filtration rate (eGFR) trend by glomerular filtration rate (GFR) category at baseline. Bars in the graph indicate SD
Figure 3
Figure 3
Estimated glomerular filtration rate (eGFR) deviation distribution for (A) year 1 and (B) year 5. Individual level variation represented by line graphs using raw deviation from baseline value for each patient. Each line represents an individual patient's variation from baseline eGFR value, ordered from largest reduction in eGFR to largest increase in eGFR (n = 7766). For example, (B) shows that at year 5, individual patients' difference from baseline eGFR varied from −80 to +59 mL/min/1.73 m2
See this image and copyright information in PMC

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