Tsai-Chung Li1, Tzu-Yun Yu2, Chia-Ing Li3, Chiu-Shong Liu4, Wen-Yuan Lin5, Chih-Hsueh Lin5, Sing-Yu Yang6, Jen-Huai Chiang7, Cheng-Chieh Lin8. 1. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. 2. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Biostatistics Center, College of Management, Taipei Medical University, Taiwan. 3. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. 4. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 5. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. 6. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan. 7. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. 8. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: cclin@mail.cmuh.org.tw.
Abstract
AIMS: The study evaluated associations between 3-year eGFR trajectory patterns and adverse renal event in diabetic patients. METHODS: Adverse renal event was defined as sustained eGFR <60 or one ACR >300 mg/g creatinine. Cox proportional hazards models evaluated association between eGFR trajectory patterns and adverse renal event. RESULTS: We detected six clusters. Cluster 1 had a stable but relatively low baseline eGFR level (n = 823, 20.52%), cluster 2 had a high baseline eGFR level, but slightly decreased afterwards (n = 1708, 42.59%), cluster 3 had an increasing eGFR during the first 15-month follow-up and then a decline rate (n = 505, 12.59%), cluster 4 decreased during the first 9-month follow-up and then remained stable (n = 774, 19.30%), cluster 5 had a sharp decline and then was elevated after 21 months until the end of follow-up (n = 135, 3.37%), and cluster 6 had an extremely fluctuating eGFR and then a sharp increase at the last 12-month period (n = 65, 1.62%). Clusters 1, 3, and 4 show increased adverse renal risks compared with cluster 2 (2.24, 1.69-2.97; 2.70, 2.02-3.61; and 2.15, 1.64-2.83, respectively). CONCLUSIONS: Patients with sustained low-level renal function, renal decline, or increasing trend in eGFR trajectory encountered an increased CKD risk.
AIMS: The study evaluated associations between 3-year eGFR trajectory patterns and adverse renal event in diabeticpatients. METHODS: Adverse renal event was defined as sustained eGFR <60 or one ACR >300 mg/g creatinine. Cox proportional hazards models evaluated association between eGFR trajectory patterns and adverse renal event. RESULTS: We detected six clusters. Cluster 1 had a stable but relatively low baseline eGFR level (n = 823, 20.52%), cluster 2 had a high baseline eGFR level, but slightly decreased afterwards (n = 1708, 42.59%), cluster 3 had an increasing eGFR during the first 15-month follow-up and then a decline rate (n = 505, 12.59%), cluster 4 decreased during the first 9-month follow-up and then remained stable (n = 774, 19.30%), cluster 5 had a sharp decline and then was elevated after 21 months until the end of follow-up (n = 135, 3.37%), and cluster 6 had an extremely fluctuating eGFR and then a sharp increase at the last 12-month period (n = 65, 1.62%). Clusters 1, 3, and 4 show increased adverse renal risks compared with cluster 2 (2.24, 1.69-2.97; 2.70, 2.02-3.61; and 2.15, 1.64-2.83, respectively). CONCLUSIONS:Patients with sustained low-level renal function, renal decline, or increasing trend in eGFR trajectory encountered an increased CKD risk.