title: Early renal function decline in type 2 diabetes.
abstract: OBJECTIVE
  Early decline in GFR may reflect progressive kidney disease in type 1 diabetes, but its predictive value in type 2 diabetes is uncertain.
  
  
  METHODS
  In this longitudinal study, GFR was measured serially over approximately 4.0 years in 195 Pima Indians with type 2 diabetes. Renal function decline (RFD) was defined during this initial period by an average GFR loss ≥3.3%/yr, as defined previously in type 1 diabetes. Subsequently, participants were followed for up to 17.8 years to ESRD onset, death, or December 31, 2010, whichever came first.
  
  
  RESULTS
  RFD prevalence during the initial period was 32% in 68 participants with normal baseline albuminuria (albumin/creatinine ratio [ACR] < 30 mg/g), 42% in 88 with microalbuminuria (ACR 30 to <300 mg/g), and 74% in 39 with macroalbuminuria (ACR ≥300 mg/g; P<0.001). The cumulative incidence of ESRD 10 years after the initial period was 41% in those with RFD and 15% in those without (P<0.001); 41 of the 49 ESRD cases (83.7%) occurred in participants who had or developed macroalbuminuria during the initial period. When adjusted for age, sex, diabetes duration, and hemoglobin A1c, the ESRD hazard rate was 4.78 times (95% confidence interval, 2.39-9.58) as high in those with RFD as in those without; further adjustment for albuminuria attenuated this association (hazard ratio, 1.79; 95% confidence interval, 0.82-3.91).
  
  
  CONCLUSIONS
  In type 2 diabetes, loss of GFR often occurs before the onset of macroalbuminuria, but a decline predictive of ESRD is strongly dependent on progression to macroalbuminuria.
authors.affiliation: Centers for Disease Control and Prevention, 4770 Buford Hwy, NE MS-K10, Atlanta, GA 30341-3724, USA. mpavkov@cdc.gov
authors.forename: Meda E
authors.initials: ME
authors.lastname: Pavkov
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.forename: Kevin V
authors.initials: KV
authors.lastname: Lemley
authors.forename: Clinton C
authors.initials: CC
authors.lastname: Mason
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Myers
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
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