title: Estimated glomerular filtration rate progression in UK primary care patients with type 2 diabetes and diabetic kidney disease: a retrospective cohort study.
abstract: OBJECTIVE
  To examine the rates of diabetic kidney disease (DKD) progression and associated factors, we undertook a study of estimated glomerular filtration rate (eGFR) in a historical cohort of UK primary care patients with type 2 diabetes mellitus (T2DM) and associated DKD from the Clinical Practice Research Datalink.
  
  
  METHODS
  Our eligible population were patients with definitive T2DM from a recorded diagnostic code with either a diagnosis of chronic kidney disease (CKD) or renal function test values and renal abnormalities consistent with a CKD diagnosis, identified between 1 October 2006 and 31 December 2011. Only patients with albuminuria results reported in mg/l were used for the longitudinal statistical analyses of the eGFR rate of change using multilevel models.
  
  
  RESULTS
  We identified 111,030 patients with T2DM. Among them 58.6% (95% confidence interval (CI): 58.3-58.9) had CKD and 37.2% (95% CI: 36.9-37.5%) had presumed DKD at baseline. Only 19.4% of patients had urinary albumin test results expressed as mg/l in the year prior to index date. Almost two-thirds (63.8%) of patients with T2DM and presumed DKD received prescriptions for angiotensin-converting enzyme (ACE) inhibitors or angiotensin type 1 receptor blockers (ARB) or both. Time-dependent variables that predict subsequent eGFR decline include increased albuminuria, time from index date and older age.
  
  
  CONCLUSIONS
  Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACEi or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline.
authors.affiliation: Evidera, London, UK.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-1392-6457
authors.initials: J
authors.lastname: Cid Ruzafa
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: R
authors.initials: R
authors.lastname: Paczkowski
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Boye
authors.affiliation: Evidera, London, UK.
authors.forename: G L
authors.initials: GL
authors.lastname: Di Tanna
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sheetz
authors.affiliation: Evidera, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Donaldson
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Breyer
authors.affiliation: Evidera, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Neasham
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Voelker
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors