title: Predictors of chronic kidney disease in type 2 diabetes: A longitudinal study from the AMD Annals initiative.
abstract: The identification of clinical predictors for the development of chronic kidney disease is a critical issue in the management of patients with type 2 diabetes mellitus.We evaluated 27,029 patients with type 2 diabetes mellitus and estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m and normoalbuminuria from the database of the Italian Association of Clinical Diabetologists network. Primary outcomes were eGFR <60 mL/min/1.73 m and normoalbuminuria; albuminuria and eGFR ≥60 mL/min/1.73 m; and eGFR <60 mL/min/1.73 m and albuminuria. Secondary outcomes were eGFR <60 mL/min/1.73 m and albuminuria.
  
  
  METHODS
  eGFR from serum creatinine by chronic kidney disease epidemiology collaboration equation (CKD-EPI), urinary albumin excretion, HbA1c, triglycerides, high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c), blood pressure, and body mass index.Over a 4-year period, 33.2% of patients (n = 8973) developed chronic kidney disease, 10.3% (n = 2788) showed a decline in eGFR <60 mL/min/1.73 m, 18.4% (n = 4978) developed albuminuria, and 4.5% (n = 1207) developed both features. Relative risk ratios (RRRs) for age (1.37, P < 0.001 by 5 years), sex (0.77, P < 0.001 for being male), body mass index (1.03, P < 0.001 by 1 kg/m), triglycerides (1.02, P < 0.001 by 10 mg/dL), and LDL-c (0.97, P = 0.004 by 10 mg/dL) were independently related to the onset of eGFR reduction. Age (1.08, P < 0.001 by 5 years), sex (1.36, P < 0.001 for being male), body mass index (1.02, P < 0.001 by 1 kg/m), triglycerides (1.01, P = 0.02 by 10 mg/dL), HDL-c, and LDL-c (0.97, P = 0.008 and 0.99, P = 0.003 by 5 and 10 mg/dL, respectively) were related to the onset of albuminuria. HbA1c and the intensity of antihypertensive treatment showed a weaker association with renal outcome.Reduction in eGFR and albuminuria showed distinct sets of risk factors, suggesting that different mechanisms are involved in the development of these 2 components of diabetic kidney disease.
authors.affiliation: Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG) Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova Diabetes and Metabolism Unit ASL Turin 5, Chieri (TO), Italy Institut d'Investigacions Biomèdiques August Pii Sunyer (IDIBAPS) and Centro de Investigación Biomédicaen Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain Department of Clinical and Experimental Medicine, 2 University of Naples, Caserta Department of Clinical and Experimental Medicine, University of Messina, Messina Center for Outcomes Research and Clinical Epidemiology, Pescara Associazione Medici Diabetologi, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Cosmo
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Pacilli
authors.forename: Carlo
authors.initials: C
authors.lastname: Giorda
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.forename: Sandro
authors.initials: S
authors.lastname: Gentile
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Russo
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rossi
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors
chemical_list: D015415:Biomarkers