Renal disease progression and associated factors in type 2 diabetes patients: A retrospective cohort study

Q: What are the key findings of this study?

Hypertension significantly increased the risk of doubling serum creatinine (HR 1.33) in patients with type 2 diabetes, along with uncontrolled blood glucose and high total cholesterol.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes mellitus (n=3465). Intervention: Hypertension vs. Normal blood pressure (SBP <140 and DBP <90 mmHg). Primary outcome: Doubling of serum creatinine (DSC) (HR 1.33, 95% CI 1.18-1.51, p=<0.001).

Q: What does this research mean for the field?

Hypertension, elevated HbA1c, and high lipid levels significantly accelerate renal disease progression in type 2 diabetes patients, whereas a BMI of 25.0 kg/m² or higher is associated with a lower hazard of doubling serum creatinine. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the survival time of renal disease progression using doubling of serum creatinine (DSC) and to identify associated clinical risk factors in patients with type 2 diabetes mellitus.

Anunya Pradidthaprecha; Benja Muktabhant; Frank Peter Schelp; Sajja Tatiyanupanwong; Wilaiphorn Thinkhamrop; Nathaphop Chaichaya

doi:10.14456/apst.2022.83

October 25, 2022Asia-Pacific Journal of Science and TechnologyOpen Access

Renal disease progression and associated factors in type 2 diabetes patients: A retrospective cohort study

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Key result

Hypertension is linked to ~33% higher risk of doubling serum creatinine in type 2 diabetes.

HR 1.33
95% CI 1.18-1.51
P<0.001
n=3,465

Why the study?

Predicting renal disease progression in patients with type 2 diabetes is an important clinical and policy challenge.

Key Points

To evaluate the survival time of renal disease progression using doubling of serum creatinine (DSC) and to identify associated clinical risk factors in patients with type 2 diabetes mellitus.
Retrospective cohort study analyzing electronic medical record data from 2011 to 2017 of N=3,465 patients with type 2 diabetes mellitus at a tertiary provincial hospital in Thailand.
Renal disease progression was defined as doubling of serum creatinine (DSC) over a total follow-up duration of 198,175 person-months.
Survival time was evaluated using the Kaplan-Meier method, and multivariable Cox proportional hazard models were applied to identify independent predictors of DSC.
A total of 1,028 of 3,465 patients (29.7%) experienced DSC, reflecting an incidence rate of 5.0 per 1,000 person-months and a median survival time of 81.5 months (95% CI: 79.28–83.74).
Significant independent risk factors for DSC included total cholesterol ≥240 mg/dl (adjusted hazard ratio [aHR]: 1.58, 95% CI: 1.32–1.87; p<0.001), hypertension (aHR: 1.33, 95% CI: 1.18–1.51; p<0.001), glycated hemoglobin ≥7.0% (aHR: 1.27, 95% CI: 1.07–1.51; p=0.005), and triglycerides ≥200 mg/dl (aHR: 1.17, 95% CI: 1.01–1.34; p=0.032).
Body mass index ≥25.0 kg/m2 was inversely associated with DSC (aHR: 0.80, 95% CI: 0.71–0.91; p=0.001), as was age 40–59 years (aHR: 0.59, 95% CI: 0.44–0.81; p=0.001) and age ≥60 years (aHR: 0.71, 95% CI: 0.53–0.97; p=0.031) compared with age 20–39 years.

Study Design

Type

Cohort (n=3,465)

Multicenter

No

Structured PICO

P

Population

3,465 adults aged 20 years and older with type 2 diabetes and normal baseline kidney function, followed for up to 7 years to assess renal disease progression.

O

Outcome

Doubling of serum creatinine (DSC)surrogate

Main Result

Hazard Ratio: 1.33 (95% CI 1.18–1.51)

p-value: p=<0.001

Hypertension, uncontrolled blood glucose, and dyslipidemia are significant predictors of renal disease progression in patients with type 2 diabetes.

Limitations

Important variables such as albuminuria, medication, and treatment adherence could not be assessed.
Did not consider the final clinical status of the patient, such as whether they died of CKD or had other comorbidities.
Residual confounding may have influenced the study results.
Important variables such as albuminuria, medication, and treatment adherence could not be assessed
Did not consider the final clinical status of the patient (whether they died of CKD or had other comorbidities)
Residual confounding may have influenced the study results

Implication

May support closer monitoring of BP, glucose, and lipids in T2DM; leaves open whether optimizing these factors slows renal progression.

Abstract

Predicting renal disease progression in patients with diabetes is an important clinical and policy challenge. This study aimed to investigate the survival function of renal disease progression by assessing the doubling of serum creatinine (DSC) over time and the factors associated with DSC in patients with type 2 diabetes mellitus (T2DM). This retrospective cohort study included 3,465 T2DM patients from a tertiary hospital in Thailand. Patients’ data from 2011 to 2017 were extracted from the electronic medical records. The Kaplan-Meier method and Cox’s proportional hazard model were analyzed to determine the survival time of T2DM patients with DSC and the factors associated with DSC. Results showed that at the end of the follow-up period, 1,028 of 3,465 patients underwent DSC. The incidence rate of DSC was 5.0/1,000 person-months. The median survival time of DSC was 81.5 months (95% confidence interval [CI]: 79.28 – 83.74). The variables associated with an increased hazard ratio of DSC were high triglyceride level (≥200 mg/dl) (adjusted hazard ratio (aHR): 1.17, 95% CI: 1.01 – 1.34), hypertension (aHR: 1.33, 95% CI: 1.18 – 1.51), high glycated hemoglobin level (≥7.0%) (aHR: 1.27, 95% CI: 1.07–1.51), and high total cholesterol level (≥ 240 mg/dl) (aHR: 1.58, 95% CI: 1.32 – 1.87). Obesity (BMI of ≥ 25.0 kg/m2) was negatively associated with DSC (aHR: 0.80, 95% CI: 0.71 – 0.91). In conclusion, T2DM patients under observation had a median survival time of DSC of 6.8 years. Hypertension and uncontrolled blood glucose and lipids are predictors of renal disease progression in T2DM patients.

Discussion

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Cite This Study

Pradidthaprecha et al. (2022) conducted a cohort in Type 2 diabetes mellitus (n=3,465). Hypertension vs. Normal blood pressure (SBP <140 and DBP <90 mmHg) was evaluated on Doubling of serum creatinine (DSC) (HR 1.33, 95% CI 1.18-1.51, p=<0.001). Hypertension significantly increased the risk of doubling serum creatinine (HR 1.33) in patients with type 2 diabetes, along with uncontrolled blood glucose and high total cholesterol.

synapsesocial.com/papers/6ac2fd227180a622ddd4dfab https://doi.org/10.14456/apst.2022.83

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Renal disease progression and associated factors in type 2 diabetes patients: A retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Renal disease progression and associated factors in type 2 diabetes patients: A retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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