1407-P: Long-Term Residence at High Altitude and Renal Outcomes in Type 2 Diabetes: A Prospective Cohort Study

Introduction and Objective: Diabetic kidney disease (DKD) is the primary driver of end-stage renal disease (ESRD) and a major contributor to cardiovascular risk and mortality in patients with T2D. However, whether long-term residence at high altitude influences renal outcomes in patients with DKD remains unclear. Methods: This prospective cohort study enrolled 387 patients aged 18-79 years with DKD and eGFR >30 mL/min/1.73 m2 from our hospital between 2020 and 2024. Participants were stratified by residential altitude into three groups: low (<1500 m), high (1500-3500 m), and extreme high altitude (≥3500 m). DKD progression was defined as a ≥50% decline in eGFR from baseline, a doubling of the serum creatinine, onset of ESRD, or renal death. Results: Baseline characteristics are summarized in Table 1. Over a mean follow-up of 3.0 years, 56 (14.5%) patients experienced DKD progression. Multivariable Cox regression analysis revealed a graded association with altitude: compared with participants residing at low altitude, those at high altitude had an adjusted HR of 2.06 (95% CI: 0.82-5.16; P=0.124) for DKD progression, whereas those at extreme altitude had a significantly increased risk, with an adjusted HR of 2.41 (95% CI: 1.11-5.27; P=0.027). Conclusion: Long-term exposure at extreme high altitude may be associated with accelerated DKD progression in patients with T2D. Further prospective, multicenter studies are warranted to validate these findings.