1. Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank
- Author
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Qiao Jin, Andrea O. Luk, Eric S.H. Lau, Claudia H.T. Tam, Risa Ozaki, Cadmon K.P. Lim, Hongjiang Wu, Guozhi Jiang, Elaine Y.K. Chow, Jack K. Ng, Alice P.S. Kong, Baoqi Fan, Ka Fai Lee, Shing Chung Siu, Grace Hui, Chiu Chi Tsang, Kam Piu Lau, Jenny Y. Leung, Man-wo Tsang, Grace Kam, Ip Tim Lau, June K. Li, Vincent T. Yeung, Emmy Lau, Stanley Lo, Samuel Fung, Yuk Lun Cheng, Chun Chung Chow, Yu Huang, Hui-yao Lan, Cheuk Chun Szeto, Wing Yee So, Juliana C.N. Chan, Ronald C.W. Ma, Cadmon King Poo Lim, Jenny Y.Y. Leung, Man Wo Tsang, Elaine Cheung, June Kam-yin Li, Vincent T.F. Yeung, Samuel K.S. Fung, Stephen Kwok-wing Tsui, Weichuan Yu, Brian Tomlinson, Si Lok, Ting Fung Chan, Kevin Yuk-lap Yip, Xiaodan Fan, Nelson L.S. Tang, Xiaoyu Tian, Shi Mai, Eric S. Lau, Fei Xie, Sen Zhang, Pu Yu, Meng Wang, Heung Man Lee, Fangying Xie, Alex C.W. Ng, Grace Cheung, Ming Wai Yeung, Kitty K.T. Cheung, Rebecca Y.M. Wong, So Hon Cheong, Katie K.H. Chan, Chin-san Law, Anthea Ka Yuen Lock, Ingrid Kwok Ying Tsang, Susanna Chi Pun Chan, Yin Wah Chan, Cherry Chiu, Chi Sang Hung, Cheuk Wah Ho, Ivy Hoi Yee Ng, Juliana Mun Chun Fok, Kai Man Lee, Hoi Sze Candy Leung, Ka Wah Lee, Hui Ming Chan, Winnie Wat, Tracy Lau, Rebecca Law, Ryan Chan, Candice Lau, Pearl Tsang, Vince Chan, Lap Ying Ho, Eva Wong, Josephine Chan, Sau Fung Lam, Jessy Pang, and Yee Mui Lee
- Subjects
Heart Failure ,Male ,Kidney ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Nephrology ,Albuminuria ,Hong Kong ,Humans ,Diabetic Nephropathies ,Female ,Prospective Studies ,Renal Insufficiency, Chronic ,Biological Specimen Banks ,Glomerular Filtration Rate - Abstract
Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes.Multicenter prospective cohort study.19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank.DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR.All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%).Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates.Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR 30 mL/min/1.73 mPotential misclassification because of drug use.Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.
- Published
- 2022
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