Glomerular filtration rate decline in T2DM following diagnosis. The Verona newly diagnosed diabetes study-12

Abstract

Aims: Nephropathy is a complication of type 2 diabetes, with increased albuminuria and reduced glomerular filtration rate (GFR) as biomarkers. Rates of progression to end-stage-renal disease are variable among patients. In this study we have examined the GFR decline in newly diagnosed T2DM.

Methods: A cohort of 410 patients with newly diagnosed T2DM and with at least four serum creatinine during the follow-up period were recruited. A linear model was used to calculate the decline in eGFR. A multivariable logistic model was used to identify independent predictors of rapid eGFR decline.

Results: Average follow-up was 12.4 years. The eGFR change was -0.80 ± 2.23 ml/min/1.73 m² per year. Patients were arbitrarily stratified into rapid decliners (≤-3.0 ml/min/1.73 m² per year), moderate decliners (-2.9/-1 ml/min/1.73 m² per year) and slow/no decliners (>-1.0 ml/min/1.73 m² per year). Subjects in the 3 categories were 11.4%, 27.3%, and 61.3%, respectively. Albuminuria was the stronger predictor of rapid eGFR decline.

Conclusions: A rapid decline in eGFR occurs in approximately 1 out of 10 newly diagnosed subjects. This rapid decline can be predicted by widely accessible clinical features, such as albuminuria. Identification of rapid decliners may help to reduce progression toward advanced stages of nephropathy.

Keywords: Glomerular filtration rate; Nephropathy; Newly diagnosed diabetes; Type 2 diabetes; eGFR decline.