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January 20, 2022
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Non-albuminuric diabetic kidney disease associated with CVD, CKD risks regardless of eGFR

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Regardless of baseline eGFR, non-albuminuric diabetic kidney disease correlated with increased risks of hospitalization for heart failure and chronic kidney disease progression.

“Both eGFR and urinary albumin-creatinine ratio have been associated with heart failure, but to the best of our knowledge, the risk of heart failure across different diabetic kidney disease (DKD) phenotypes [has] not been well investigated,” Qiao Jin, MSc, from the department of medicine and therapeutics at The Chinese University of Hong Kong Prince of Wales Hospital in Hong Kong, and colleagues wrote. “We aimed to assess the risks of all-cause mortality, CVD, hospitalization for heart failure (HHF) and CKD progression in decreased eGFR only group in comparison with other DKD phenotypes.”

In a multicenter prospective cohort study, researchers evaluated 19,025 Chinese adults (mean age was 61.1 years; 58.3% were men) with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Jin and colleagues defined DKD phenotypes by baseline eGFR and albuminuria. Using multivariable Cox proportional or cause-specific hazard models, researchers approximated the risks of death, HHF and CKD progression.

In 54,260 person-years of follow-up, researchers identified 438 deaths; 1,076 cases of CVD; 298 cases of HHF and 1,161 episodes of CKD progression. Analyses revealed patients with non-albuminuric DKD were at increased risk of death, hospitalization for heart failure and CKD progression compared with patients without DKD. However, after adjusting for a wide range of confounders, all adverse outcomes were increased among patients with albuminuric DKD. Overall, risks of death, CVD, HHF and CKD progression were higher in the setting of albuminuria regardless of decreased eGFR.

“Non-albuminuric DKD was associated with higher risks of HHF and CKD progression than no DKD, regardless of baseline eGFR,” Jin and colleagues wrote.

According to the researchers, limitations of the study included only Chinese participants and potential misclassification because of SGLT2 use.