The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

Abstract

Background: There are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population.

Methods: In this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline.

Results: We followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD.

Conclusions: Patients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.

Keywords: acute kidney injury; chronic kidney disease; diabetes mellitus; epidemiology and outcomes.

Graphical abstract

Figure 1.

The GoDarts cohort flowchart. T1DM, type 1 diabetes mellitus.

Figure 2.

Visual representation of the eGFR slope estimates in people without AKI (no AKI), before the AKI (pre-AKI), and after the AKI event (post-AKI), depending on diabetes status and CKD status at recruitment. ^aReference group includes: no AKI during follow-up, female, ≤49 years, and no cardiovascular disease. ^bReference group includes: no AKI during follow-up, female, 50–64 years, and no cardiovascular disease.