Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study

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Abstract

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 -1.4 mL/min/1.73 m2/year (95% CI -1.5 to -1.4), with undiagnosed diabetes was -1.8 mL/min/1.73 m2/year (95% CI -2.0 to -1.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was -2.5 mL/min/1.73 m2/year (95% CI -2.6 to -2.4) (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.

Original languageEnglish (US)
Pages (from-to)1646-1653
Number of pages8
JournalDiabetes Care
Volume41
Issue number8
DOIs
StatePublished - Aug 1 2018

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Glomerular Filtration Rate
Atherosclerosis
Cohort Studies
Kidney Diseases
Blood Pressure
African Americans
Linear Models
Genotype
Insulin
Hypertension
Kidney
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

@article{b8035c895569403d81fc6a41d26259d3,
title = "Diabetes and Trajectories of Estimated Glomerular Filtration Rate: A Prospective Cohort Analysis of the Atherosclerosis Risk in Communities Study",
abstract = "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 -1.4 mL/min/1.73 m2/year (95{\%} CI -1.5 to -1.4), with undiagnosed diabetes was -1.8 mL/min/1.73 m2/year (95{\%} CI -2.0 to -1.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was -2.5 mL/min/1.73 m2/year (95{\%} CI -2.6 to -2.4) (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.",
author = "Bethany Warren and Casey Rebholz and Yingying Sang and Lee, {Alexandra K.} and Josef Coresh and Elizabeth Selvin and Morgan Grams",
year = "2018",
month = "8",
day = "1",
doi = "10.2337/dc18-0277",
language = "English (US)",
volume = "41",
pages = "1646--1653",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "8",

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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

AU - Sang, Yingying

AU - Lee, Alexandra K.

AU - Coresh, Josef

AU - Selvin, Elizabeth

AU - Grams, Morgan

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 -1.4 mL/min/1.73 m2/year (95% CI -1.5 to -1.4), with undiagnosed diabetes was -1.8 mL/min/1.73 m2/year (95% CI -2.0 to -1.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was -2.5 mL/min/1.73 m2/year (95% CI -2.6 to -2.4) (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 -1.4 mL/min/1.73 m2/year (95% CI -1.5 to -1.4), with undiagnosed diabetes was -1.8 mL/min/1.73 m2/year (95% CI -2.0 to -1.7) (difference vs. no diabetes, P < 0.001), and with diagnosed diabetes was -2.5 mL/min/1.73 m2/year (95% CI -2.6 to -2.4) (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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DO - 10.2337/dc18-0277

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VL - 41

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EP - 1653

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 8

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