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Several risk factors may lead to faster renal failure in patients with diabetes

Renal failure could occur earlier in patients with diabetes, proteinuria and acute kidney injury than in those who do not have those risk factors, according to findings presented at the American Society of Nephrology Kidney Week.

Researchers said these findings could significantly impact a patient’s lifespan, and suggest these patients require more careful monitoring and aggressive treatment.

“This is a big impact for a patient. You are talking about pruning 18 to 20 years off of when you will have to go on dialysis,” Charuhas V. Thakar, MD, and director, division of nephrology, University of Cincinnati, said in a press release. “It's very important information for a patient and clinician to know. The study is among the first to examine the interrelationship between these traditional risk factors for its effect on kidney disease progression."

Thakar and colleagues followed 3,679 patients with type 2 diabetes for 10 years. The mean age of participants in the study was 61.7 years and their mean baseline estimated glomerular filtration rate (eGFR) was 79.7 mL/min. Patients with none of the risk factors — mean A1C > 7%, proteinuria and acute kidney failure (AKI) — were considered low risk. They were compared against patients with one or two risk factors (medium risk) and patients that had all three risk factors (high risk).

According to researchers, the high-risk group was more likely to reach stage IV chronic kidney disease (adjusted OR = 7.2; 95% CI 5.1–10.1) when compared with the low-risk group. The high-risk group’s eGFR showed a mean annual rate of decline of 4.33 mL/min; the medium risk group’s rate was 2.88 mL/min and the low risk group’s rate was 2.29 mL/min. Rapid decliner outcome logistic regression models showed significant positive interactions between proteinuria and mean A1C > 7% (P = .005) and between proteinuria and acute kidney injury (P = .007). The crude mortality rate was higher in rapid decliners (27.2% vs. others 20.1%; P < .0001).

Researchers said a patient’s monitoring and treatment schedule should be based on an individual’s specific risk factors.

“We have the same tools in our arsenal to help these patients in terms of their progression of kidney disease; so our research raises questions and challenges the field of physicians,” Thakar said in the release. "We should find ways to monitor these three groups of patients differently and target our therapies. Future studies need to evaluate how we are going to change the trajectory of loss of renal function in these patients who may suffer a faster decline by either modifying existing treatment or discovering new therapies." – by Janel Miller

Reference: Sands M, et al. Acute kidney injury, proteinuria, glycemic control, and kidney disease. Presented at: American Society of Nephrology Kidney Week 2016; Nov. 15-20; Chicago. 

Disclosure: The authors report funding support from the Veterans Administration.