Timothy M E Davis1, S A Paul Chubb2, Wendy A Davis3. 1. School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia tim.davis@uwa.edu.au. 2. School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia Department of Clinical BiochemistryPathWest Laboratory Medicine WA, Perth, Western Australia, Australia School of Pathology and Laboratory MedicineUniversity of Western Australia, Nedlands, Western Australia, Australia. 3. School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia.
Abstract
OBJECTIVE: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. DESIGN: Longitudinal observational study. METHODS: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. RESULTS: In the full cohort (1296 patients; mean±s.d. age 64.1±11.3years, 48.6% males), 738 (56.9%) died during 12.9±6.1years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59mL/min/1.73m(2)) as reference, the strongest association was for eGFR ≥90mL/min/1.73m(2) (hazard ratio (95% CI) 2.01 (1.52-2.66); P<0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P≤0.003) and associated median reductions in survival of 6.5 and 8.7years respectively. CONCLUSION: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.
OBJECTIVE: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. DESIGN: Longitudinal observational study. METHODS:Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. RESULTS: In the full cohort (1296 patients; mean±s.d. age 64.1±11.3years, 48.6% males), 738 (56.9%) died during 12.9±6.1years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59mL/min/1.73m(2)) as reference, the strongest association was for eGFR ≥90mL/min/1.73m(2) (hazard ratio (95% CI) 2.01 (1.52-2.66); P<0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P≤0.003) and associated median reductions in survival of 6.5 and 8.7years respectively. CONCLUSION: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.
Authors: Giuseppe Penno; Emanuela Orsi; Anna Solini; Enzo Bonora; Cecilia Fondelli; Roberto Trevisan; Monica Vedovato; Franco Cavalot; Gabriella Gruden; Luigi Laviola; Antonio Nicolucci; Giuseppe Pugliese Journal: BMJ Open Diabetes Res Care Date: 2020-07
Authors: Yuan Wang; Eric Yuk Fai Wan; Ivy Lynn Mak; Margaret Kay Ho; Weng Yee Chin; Esther Yee Tak Yu; Cindy Lo Kuen Lam Journal: PLoS One Date: 2022-01-27 Impact factor: 3.240