What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus (n=471). Intervention: Macroalbuminuria (CKD3aA3) vs. Normoalbuminuria (CKD3aA1). Primary outcome: Progression to CKD stage 5 within 5 years (p=<0.00001).

What does this research mean for the field?

In patients with type 2 diabetes and CKD stage 3a, macroalbuminuria is associated with a significantly higher rate of progression to CKD stage 5 and increased multimorbidity over 5 years compared to normoalbuminuria. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 25, 2023PLoS ONEOpen Access

Association and progression of multi-morbidity with Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus, grouped by albuminuria status in the multi-ethnic population of Northwest London: A real-world study

Q: What are the key findings of this study?

Patients with CKD stage 3a and macroalbuminuria (CKD3aA3) had a significantly higher rate of progression to CKD stage 5 within 5 years compared to those with normoalbuminuria (14.0% vs 1.34%, p<0.00001).

Q: What does this research mean for the field?

In patients with type 2 diabetes and CKD stage 3a, macroalbuminuria is associated with a significantly higher rate of progression to CKD stage 5 and increased multimorbidity over 5 years compared to normoalbuminuria. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Macroalbuminuria in CKD 3a linked to ~10-fold higher 5-year progression to CKD 5 versus normoalbuminuria.

P<0.00001
n=471

Why the study?

Real-world data linking glomerular function and albuminuria to the degree of multi-morbidity in diabetic kidney disease secondary to type 2 diabetes mellitus is lacking.

Population

1082 patients with T2DM diagnosed with CKD stage 3a in 2015

Comparison

Patients grouped by degree of albuminuria (CKD3aA1 vs CKD3aA2 vs CKD3aA3)

Design

Real-world retrospective cohort study using the Discover dataset

Follow-up

5 years

Authors

RDRakesh DattaniImperial College Healthcare NHS Trust ZHZia Ul HaqKhyber Medical University MSMoulesh ShahImperial College London

Discussion

Member takes

Implication

CKD3aA3 signals high ESKD progression risk in T2DM warranting vigilance; hypothesis-generating for refined stratification pending prospective trials.

Study Design

Type

Cohort (n=471)

Structured PICO

Population

471 patients over 40 years of age with Type 2 Diabetes Mellitus and newly diagnosed CKD stage 3a, stratified by albuminuria status, followed for 5 years.

Outcome

Baseline and 5-year development of co-morbidities (hypertension, retinopathy, ischaemic heart disease, heart failure, vascular disease) and progression to CKD stage 5.hard clinical

Main Result

Absolute Event Rate: 14% vs 1.34%

p-value: p=<0.00001

In patients with T2DM and CKD stage 3a, macroalbuminuria (CKD3aA3) is strongly associated with progression to end-stage kidney disease and the development of heart failure compared to normo- or microalbuminuria.

Limitations

Relatively short follow-up period of five years, potentially underestimating certain long-term complications.
Lacks a true control group of patients with T2DM who do not develop CKD.
Baseline RAASi prescription may have reduced albuminuria levels, potentially misclassifying some patients' baseline albuminuria status.
High exclusion rate (56.5%) due to patients not having a uACR performed in the same calendar year as their CKD3a diagnosis.

Cite This Study

Dattani et al. (2023) conducted a cohort in Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus (n=471). Macroalbuminuria (CKD3aA3) vs. Normoalbuminuria (CKD3aA1) was evaluated on Progression to CKD stage 5 within 5 years (p=<0.00001). Patients with CKD stage 3a and macroalbuminuria (CKD3aA3) had a significantly higher rate of progression to CKD stage 5 within 5 years compared to those with normoalbuminuria (14.0% vs 1.34%, p<0.00001).

synapsesocial.com/papers/6aa4be529bfc60db01142891 https://doi.org/10.1371/journal.pone.0289838

Topics

Heart failure HFrEF treatment Hypertension management HFpEF management

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Implication

CKD3aA3 signals high ESKD progression risk in T2DM warranting vigilance; hypothesis-generating for refined stratification pending prospective trials.

Association and progression of multi-morbidity with Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus, grouped by albuminuria status in the multi-ethnic population of Northwest London: A real-world study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Association and progression of multi-morbidity with Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus, grouped by albuminuria status in the multi-ethnic population of Northwest London: A real-world study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider