Among patients with diabetic kidney disease (DKD), those of Afro-Caribbean ethnicity are more likely to exhibit a non-linear decline in estimated glomerular filtration rate (eGFR) that is associated with faster progression to kidney failure, a new study finds.

Of 398 patients with DKD from a specialty diabetes clinic, 71 (18%) reached end-stage kidney disease (ESKD), including 42 who had a non-linear eGFR trajectory. Sixteen patients exhibited an “accelerator” trajectory characterized by a stable decline in kidney function followed by a steep drop in eGFR. Nine patients had a “decelerator” trajectory characterized by a stable decline in kidney function followed by a slower decrease in eGFR. Seventeen patients exhibited a “stepwise” trajectory where eGFR fell and rose unpredictably.

After multinomial regression and other analyses, only African-Caribbean ethnicity (62% of cohort) and glycemic variability were independently associated with non-linear eGFR trajectories and faster progression to ESKD, Stanimir Stoilov, BSc, and colleagues from Guy’s and St Thomas’ NHS Foundation Trust in London, UK, reported in the Journal of Diabetes and Its Complications. Compared with all other ethnicities, African-Caribbean ethnicity was associated with significant 10.6-fold increased odds of an accelerator trajectory. Higher hemoglobin A1c (HbA1c) variability was significantly associated with 1.2-fold increased odds of a stepwise trajectory.

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The investigators did not observe any effect of blood pressure variability (83.1% of patients received uninterrupted renin-angiotensin system [RAS] blockade). At baseline, the mean eGFR was 67.8 mL/min/1.73 m2, HbA1c was 9.4%, and 93% had albuminuria. By design, patients with a history of acute kidney injury were excluded from the study.

“These findings are a guiding point for future work which should focus on establishing robust methods for predicting eGFR decline based on early trajectories and associated risk factors, thus enabling individualized care for those at highest risk of rapid progression to ESRD,” according to the investigators.


Stoilov SI, Fountoulakis N, Panagiotou A, Thomas S, Karalliedde J. Non-linear renal function decline is frequent in patients with type 2diabetes who progress fast to end-stage renal disease and is associated with African-Caribbean ethnicity and HbA1c variability. J Diabetes Complications 35(5):107875. doi:10.1016/j.jdiacomp.2021.107875