Onset and progression of kidney disease in type 2 diabetes among multi-ethnic Asian population.
To elucidate the natural history of chronic kidney disease(CKD), which is defined as estimated glomerular filtration rate(eGFR)<60ml/min/1.73m(2) and/or increase of urinary albumin-to-creatinine ratio (uACR)≥30mg/g), and to identify factors associated with its onset and progression.



Prospective cohort study on individuals with T2DM attending Diabetes Centre in a regional hospital in Singapore from 2002. There were 553 patients with no pre-existing CKD for "onset" analysis and 967 patients with pre-existing CKD for "progression" analysis. Multivariable logistic regression was performed to determine risk factors of the outcomes.



The mean follow-up period was 5.8years (4.5-7.1) and 5.3years (3.9-6.9) for the onset and progression cohorts respectively. About 45% of individuals developed CKD and 41% had progression. Among subjects with CKD onset, albuminuria-only occurred in 75% of them. Majority of the patients remained in the same CKD risk-category during follow-up. Progression and regression occurred across all CKD-categories. Transitions to adjacent risk-category were much more likely than transitions bypassing adjacent state. Risk factors for CKD onset included baseline albuminuria, eGFR, HbA1c variability, body mass index, triglycerides and age (all P<0.05). The predictors for CKD progression or rapid-progression included HbA1c variability, baseline albuminuria, systolic blood pressure, LDL-cholesterol, eGFR, HbA1c and ethnicity (all P<0.05).



Albuminuria was the first manifestation of CKD in most T2DM patients. Transition across CKD-category occurred bi-directionally, but evolved largely in a stepwise fashion. The onset and progression of CKD were predicted by multiple risk factors, some of which were modifiable.
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore. Electronic address: low.serena.km@alexandrahealth.com.sg.
Serena
S
Low
Department of Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore.
E Shyong
ES
Tai
Department of Medicine, Khoo Teck Puat Hospital, Singapore.
Lee Ying
LY
Yeoh
Department of Medicine, Khoo Teck Puat Hospital, Singapore.
Yan Lun
YL
Liu
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Jian Jun
JJ
Liu
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Kristin Hui Xian
KH
Tan
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Sharon
S
Fun
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Chang
C
Su
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Xiao
X
Zhang
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Tavintharan
T
Subramaniam
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Chee Fang
CF
Sum
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Su Chi
SC
Lim
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000209:etiology*; D012846:Singapore
Chronic kidney disease; Diabetes; Onset; Progression; Transition