Article Predictors of Estimated GFR Decline in Patients with Type 2 Diabetes

Background and objectives This study examined predictors of the annual decline in estimated GFR (eGFR) in patients with type 2 diabetes and preserved kidney function. Design, setting, participants, &measurements In a prospective, observational cohort study, 1682 individualswith type 2 diabetes and baseline eGFR $60 ml/min per 1.73 m2 (as estimated by the Chronic Kidney Disease Epi-demiology Collaboration equation) were followed for 10 years. Linear regression was used to estimate partic-ipants ’ changes in eGFR over time. ResultsDuring follow-up, 263 (15.6%) individuals had a rapid eGFR decline defined as.4.0 % per year. Average eGFR decline was 25.863 and 20.662 ml/min per 1.73 m2 per year in rapid decliners and nondecliners, re-spectively. Compared with normotensive, normoalbuminuric patients (20.260.2 ml/min per 1.73 m2 per year), those with hypertension (21.060.1 ml/min per 1.73 m2 per year), hemoglobin A1c$7 % (21.060.1 ml/min per 1.73 m2 per year), longer diabetes duration (21.060.1 ml/min per 1.73 m2 per year), obesity (21.260.1 ml/min per 1.73 m2 per year), insulin treatment (21.560.1 ml/min per 1.73 m2 per year), microalbuminuria (21.360.2 ml/min per 1.73 m2 per year), or macroalbuminuria (22.760.4 ml/min per 1.73 m2 per year) had significantly faster age-adjusted annual eGFR declines. Multivariable linear regression analyses revealed that albuminuria (P,0.001) was the strongest predictor of annual eGFR decline. Other independent predictors of annual eGFR decline were older age, hypertension, insulin treatment, and lower baseline eGFR. ConclusionsAnnual eGFR decline is predicted bymultiplemodifiable risk factors in patients with type 2 diabetes and preserved kidney function