Abstract
BackgroundDiabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing.MethodsHere we investigated the association of clinical variables and quality of care measures with eGFR+ and Alb+ in 157,595 T2DM individuals participating to the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, stratified by age.ResultsThe prevalence of eGFR+ and Alb+ increased with ageing, although this increment was more pronounced for low eGFR. Irrespective of age, both the eGFR+ and Alb + groups had the worst risk factors profile when compared to subjects without renal disease, showing a higher prevalence of out-of target values of HbA1c, BMI, triglycerides, HDL-C, blood pressure and more complex cardiovascular (CVD) and anti-diabetic therapies, including a larger use of insulinIn all age groups, these associations differed according to the specific renal outcome examined: male sex and smoking were positively associated with Alb+ and negatively with eGFR+; age and anti-hypertensive therapies were more strongly associated with eGFR+, glucose control with Alb+, whereas BMI, and lipid-related variables with both abnormalities. All these associations were attenuated in the older (> 75 years) as compared to the younger groups (< 65 years; 65–75 years), and they were confirmed by multivariate analysis. Notably, Q-score values < 15, indicating a low quality of care, were strongly associated with Alb+ (OR 8.54; P < 0.001), but not with eGFR+.ConclusionsIn T2DM patients, the prevalence of both eGFR and Albuminuria increase with age. DKD is associated with poor cardiovascular risk profile and a lower quality of care, although these associations are influenced by the type of renal abnormality and by ageing. These data indicate that clinical surveillance of DKD should not be unerestimated in old T2DM patients.
Highlights
Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM)
In the large cohort of the Italian Association of Clinical Diabetologists (AMD) Annals Initiative, we have recently demonstrated that low estimated glomerular filtration rate (eGFR) and albuminuria may have different associations with clinical variables and risk factors for cardiovascular disease (CVD) [9]
In spite of the large prevalence of DKD among elderly type 2 diabetes mellitus (T2DM) patients, it is still unclear whether ageing modifies the associations of low eGFR and albuminuria with CVD risk factors, a relevant issue when considering that DKD is associated with an enormous CVD burden, even at older ages [10, 11]
Summary
Diabetic kidney disease (DKD) is a major burden in elderly patients with type 2 diabetes (T2DM). Low estimated glomerular filtration rate (eGFR+, < 60 mL/min/1.73 m2) and albuminuria (Alb+) are essential for the diagnosis of DKD, but their association with clinical variables and quality of care may be influenced by ageing. Senescence is associated with a progressive decline of estimated glomerular filtration rate (eGFR) of about 1–2 ml/min per year, T2DM is a progressive disease [7] whose prevalence increases with age [8], exposing elderly patients to an increased risk of long-term diabetic complications, including diabetic kidney disease (DKD). In spite of the large prevalence of DKD among elderly T2DM patients, it is still unclear whether ageing modifies the associations of low eGFR and albuminuria with CVD risk factors, a relevant issue when considering that DKD is associated with an enormous CVD burden, even at older ages [10, 11].
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