Progression of albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years in people with type 2 diabetes. Drivers, potential protectors and associated mortality

INTRODUCTION: The pathophysiology of chronic kidney disease (CKD) and type 2 diabetes (T2D) is multifactorial and associated with a plethora of underlying conditions and complications. Their link is reciprocal and understanding its nature, particularly over time, could improve the health of many. METHODS: A prospective study was conducted to examine the development of the two main components of CKD (urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR)) over 24 years (2001-2024) in a sample of 718 individuals with a diagnosis of T2D. Longitudinal modelling was conducted to examine the rate of change of ACR and eGFR over the 24 years, as well as whether sex, smoking status, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) influenced that rate of change in both our total sample and three sub-groups (no CKD, CKD with increased ACR and preserved eGFR, and CKD with increased ACR and reduced eGFR). RESULTS: ). CONCLUSION: . Mortality rate was profoundly influenced by historical CKD status.