TY - JOUR
T1 - Diabetes and trajectories of estimated glomerular filtration rate
T2 - A prospective cohort analysis of the atherosclerosis risk in communities study
AU - Warren, Bethany
AU - Rebholz, Casey M.
AU - Sang, Yingying
AU - Lee, Alexandra K.
AU - Coresh, Josef
AU - Selvin, Elizabeth
AU - Grams, Morgan E.
N1 - Funding Information:
Some of the data reported in this study have been supplied by the USRDS registry. The interpretation and reporting of these data are the responsibilityoftheauthorsandinnowayshould be seen as official policy or interpretation of the U.S. government. Funding. The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN268201700002I. B.W. and A.K.L. were supported by National Institutes of Health (NIH)/ NHLBI grant T32-HL-007024. C.M.R. was supported by a mentored research scientist development grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (K01-DK-107782). E.S. was supported by NIH/ NIDDK grants K24-DK-106414 and R01-DK-089174. M.E.G. was supported by NIH/NIDDK grant K08-DK-092287. Reagents for the 1,5-anhydroglucitol assays were donated by the GlycoMark Corporation. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. B.W. and M.E.G. researched the data and wrote the manuscript. C.M.R., Y.S., A.K.L., J.C., and E.S. reviewed and edited the manuscript. M.E.G. is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2018 by the American Diabetes Association.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - OBJECTIVE: To characterize long-term kidney disease trajectories in persons with and without diabetes in a general population. RESEARCH DESIGN AND METHODS: We classified 15, 517 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study by diabetes status at baseline (1987-1989; no diabetes, undiagnosed diabetes, and diagnosed diabetes). We used linear mixed models with random intercepts and slopes to quantify estimated glomerular filtration rate (eGFR) trajectories at four visits over 26 years. RESULTS: Adjusted mean eGFR decline over the full study period among participants without diabetes was 21.4 mL/min/1.73 m2/year (95% CI 21.5 to 21.4), with undiagnosed diabetes was 21.8 mL/min/1.73 m2/year (95% CI 22.0 to 21.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was 22.5 mL/min/1.73 m2/year (95% CI 22.6 to 22.4) (difference vs. no diabetes, P < 0.001). Among participants with diagnosed diabetes, risk factors for steeper eGFR decline included African American race, APOL1 high-risk genotype, systolic blood pressure ≥140 mmHg, insulin use, and higher HbA1c. CONCLUSIONS: Diabetes is an important risk factor for kidney function decline. Those with diagnosed diabetes declined almost twice as rapidly as those without diabetes. Among people with diagnosed diabetes, steeper declines were seen in those with modifiable risk factors, including hypertension and glycemic control, suggesting areas for continued targeting in kidney disease prevention.
AB - OBJECTIVE: To characterize long-term kidney disease trajectories in persons with and without diabetes in a general population. RESEARCH DESIGN AND METHODS: We classified 15, 517 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study by diabetes status at baseline (1987-1989; no diabetes, undiagnosed diabetes, and diagnosed diabetes). We used linear mixed models with random intercepts and slopes to quantify estimated glomerular filtration rate (eGFR) trajectories at four visits over 26 years. RESULTS: Adjusted mean eGFR decline over the full study period among participants without diabetes was 21.4 mL/min/1.73 m2/year (95% CI 21.5 to 21.4), with undiagnosed diabetes was 21.8 mL/min/1.73 m2/year (95% CI 22.0 to 21.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was 22.5 mL/min/1.73 m2/year (95% CI 22.6 to 22.4) (difference vs. no diabetes, P < 0.001). Among participants with diagnosed diabetes, risk factors for steeper eGFR decline included African American race, APOL1 high-risk genotype, systolic blood pressure ≥140 mmHg, insulin use, and higher HbA1c. CONCLUSIONS: Diabetes is an important risk factor for kidney function decline. Those with diagnosed diabetes declined almost twice as rapidly as those without diabetes. Among people with diagnosed diabetes, steeper declines were seen in those with modifiable risk factors, including hypertension and glycemic control, suggesting areas for continued targeting in kidney disease prevention.
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U2 - 10.2337/dc18-0277
DO - 10.2337/dc18-0277
M3 - Review article
C2 - 29858211
AN - SCOPUS:85053936412
SN - 0149-5992
VL - 41
SP - 1646
EP - 1653
JO - Diabetes care
JF - Diabetes care
IS - 8
ER -