Study: eGFR Trajectory More Predictive of Death in Type 2 Diabetes

The study highlights a need to monitor eGFR regularly, even in patients who have yet to develop renal impairment of concern.
The study highlights a need to monitor eGFR regularly, even in patients who have yet to develop renal impairment of concern.

Type 2 diabetes patients with rapid renal decline following a high estimated glomerular filtration rate (eGFR) may have an increased risk of death, a new study suggests.

Researchers led by Timothy Davis, MBBS, DPhil, of the University of Western Australia, investigated eGFR and death from any cause in 1,296 type 2 diabetes patients who participated in the Fremantle Diabetes Study Phase I. In a subset of 532 patients, they also explored the predictive value of baseline eGFR category (stage 1 to 5) compared with eGFR trajectory, which was modeled based on 6 annual eGFR measurements. The model accounted for time-related changes in disease parameters and changes in hemoglobin A1C.

Over 12 years, 738 patients died, according to results published online ahead of print in the European Journal of Endocrinology. In agreement with a 2012 meta-analysis published in the Lancet (380;1662-1673), analyses revealed a U-shaped relationship between all-cause mortality and eGFR category, with high and low baseline eGFR associated with higher risks. The risk of death was doubled for patients with baseline eGFR ≥90 mL/min/1.73 m2 when stage 3 eGFR (45 to 59 mL/min/1.73m2) was used as a reference.

Additionally, eGFR trajectory proved even more predictive. Modeling revealed 4 eGFR trajectories: low, medium, high, and high/declining. Both the low and high/declining trajectories were associated with a greater than 2-fold increased risk of death when medium trajectory was used for reference. The risks translated to median reductions in survival of 6.5 and 8.7 years, respectively.

Identifying type 2 diabetes patients with the high/declining eGFR should be a priority, according to the investigators. “We would recommend annual monitoring of the eGFR in all patients with type 2 diabetes, even those with normal renal function and especially patients who are hyperfiltrators, to identify those whose decline in renal function with time is higher than expected for age and diabetes status (above 2 mL/min/1.73 m2 per year),” Dr Davis told Renal & Urology News. “These patients should be managed intensively in terms of cardiovascular risk factors given that they have a relatively poor prognosis.”

Source

1. Davis TM, Chubb SA, and Davis W. The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: The Fremantle Diabetes Study. Eur J Endocrinol. 2016 Jul 14. pii: EJE-16-0327. doi: 10.1530/EJE-16-0327.  [Epub ahead of print].

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