Abstract
AimTo characterize the longitudinal variability of estimated glomerular filtration rate (eGFR) in people with type 2 diabetes mellitus (T2DM), including variation between categories and individuals.MethodsPeople 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.ResultsIn 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).ConclusionOverall, 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.
Highlights
Diabetes is a leading cause of chronic kidney disease (CKD)(1) and it is expected that between 40-50% of people with type 2 diabetes mellitus (T2DM) will be affected by CKD in their lifetime.[2,3,4] only a small number of glucose-lowering therapies can be used safely in people with renal impairment without requiring a dose adjustment.[5]
Clinical Practice Research Datalink (CPRD) is linked to Hospital Episode Statistics (HES), a database containing details of all hospital admissions, accident and emergency attendances and outpatient appointments, to improve ethnicity recording for GFR estimation.[17]. Study population Individuals were identified in CPRD based on their first diagnosis code of T2DM
To estimate GFR CKD-EPI requires data for serum creatinine, age, sex and ethnicity.[18]. The CKD-EPI equation was selected as it is the recommended formula by the National Institute for Heath and Care Excellence (NICE).(19) Individuals were grouped into GFR categories, as adopted by NICE guidelines, according to their estimated glomerular filtration rate (eGFR) at baseline and follow up.[19]. These are the same categories used by the Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group in their international guidelines for the management of CKD.[20]. Data analysis This was a retrospective, descriptive study
Summary
Diabetes is a leading cause of chronic kidney disease (CKD)(1) and it is expected that between 40-50% of people with type 2 diabetes mellitus (T2DM) will be affected by CKD in their lifetime.[2,3,4] only a small number of glucose-lowering therapies can be used safely in people with renal impairment without requiring a dose adjustment.[5]. Previous research has demonstrated that renal function, as measured by eGFR, can vary considerably, especially amongst people with diabetes.[6,7,8,9,10,11,12,13,14] These studies have suggested that eGFR improvement among people with T2DM is possible,(11) leading to increased complexity when considering optimal treatment. Published studies have tended to investigate renal variation at population or category level, with one such study reporting eGFR trends in the UK.[11] There are no recent studies reporting patient-level variation in renal function in a T2DM population. Using primary care clinical records, this study aims to further characterize the longitudinal variability of eGFR in a cohort of people with T2DM with availability of consistent eGFR measurements over a period of 5 years to further explore eGFR trends and patterns over a longer period, including analysis at individual patient level
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