Age-related markers and predictors of diabetic kidney disease progression in type 2 diabetes patients: a retrospective cohort study

Ther Adv Endocrinol Metab. 2024 Apr 6:15:20420188241242947. doi: 10.1177/20420188241242947. eCollection 2024.

Abstract

Background: Diabetic kidney disease (DKD) is characterized by reduced estimated glomerular filtration rate (eGFR) and albuminuria, which play a pivotal role in both diagnosing and determining the disease's progression. This study aimed to assess the trajectory of these markers concerning age in individuals with DKD and identify predictive factors for the decline in eGFR decline, variation in albuminuria, mortality, and progression to renal replacement therapy (RRT).

Design: This retrospective cohort encompassed patients with type 2 diabetes (T2D), divided into two age categories: <75 and ⩾75 years old.

Methods: Over a 3-year span, the study evaluated eGFR (CKD-EPI) and 24-h albuminuria. Univariate and multivariate analyses were employed to pinpoint factors associated with deteriorating renal function and mortality. Significance was set at p < 0.05, and Kaplan-Meier survival curves were constructed to illustrate renal and overall survival.

Results: The analysis comprised 304 patients. Comparable eGFR declines were evident in both age groups during the transition from the first to the second year and from the second to the third year. Nonetheless, a more pronounced rise in albuminuria was evident in the ⩾75 years group during the first to the second year. Multivariate analysis unveiled that systolic blood pressure (SBP) measurements in the first year positively forecasted eGFR decline. Age was associated with heightened albuminuria and mortality, while hospitalizations linked to cardiovascular causes robustly predicted mortality. Hospitalizations due to sepsis and cardiovascular reasons, coupled with first-year SBP measurements, served as predictive indicators for progression to RRT.

Conclusion: Both age groups experienced similar declines in eGFR, though the ⩾75 years group displayed a more significant increase in albuminuria during the first to the second year. Age, hospitalizations, and higher blood pressure levels were correlated with exacerbated renal function deterioration and/or elevated mortality in DKD. Timely intervention and tailored management strategies stand as critical components for enhancing outcomes among DKD patients.

Keywords: aging; albuminuria; diabetes; glomerular filtration rate; kidney disease.

Plain language summary

Diabetic kidney disease: aging and progression Diabetic kidney disease (DKD) is characterized by a reduced estimated glomerular filtration rate (eGFR) and albuminuria. This study aims to evaluate the follow-up of these renal markers in relation to age among individuals with DKD and identify factors predisposing to eGFR loss, increased albuminuria, mortality, and the need for dialysis. We conducted an observational and retrospective study in Brazil, including patients with type 2 diabetes, divided into two age groups: < 75 and ⩾ 75 years. The patients were followed for three years, and a total of 304 patients were evaluated. We observed a similar decline in eGFR in both age groups from the 1st to the 2nd year and from the 2nd to the 3rd year. However, worsening of albuminuria was more frequent in the ⩾ 75 years old group from the 1st to the 2nd year. Elevated blood pressure levels were associated with eGFR decline. Age was associated with increased albuminuria and mortality. Hospitalizations for cardiovascular causes strongly predicted mortality. Hospitalizations for sepsis and cardiovascular causes, along with higher blood pressure levels, were associated with the need for dialysis. Hence, establish approaches to enhance the health in individuals with DKD is of paramount importance.