We retrospectively screened candidates from outpatients who had visited the Division of Endocrinology and Metabolism. This observational cohort study was conducted in Taichung Veterans General Hospital. Therefore, we conducted a retrospective cohort study to investigate the association between the standard deviation (SD) of previously measured eGFR values and mortality in type 2 DM patients with and without CKD. We hypothesized the existence of a synergistic effect of eGFR and previous eGFR variability on mortality prediction in patients with type 2 DM. These inconsistent results might be explained by the various CKD stages and presence of DM in the study population.
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However, a recent post hoc analysis from the ADVANCE trial reported that eGFR variability was significantly associated with the primary outcome, including major macrovascular events, new or worsening nephropathy and all-cause mortality, but eGFR variability was not significantly associated with all-cause mortality as a secondary outcome in patients with type 2 DM. reported that eGFR variability could significantly predict mortality in patients with stage 3 CKD. The variability in eGFR has been reported to be associated with new-onset DM in a Korean population and with CKD progression in the population with DM. Similarly, based on the data of National Health Insurance in Taiwan, the rate of annual eGFR assessments was 74.2% and that of UACR was 35.9% in 2014. Īlthough the rate of annual eGFR assessments could be greater than 80%, the rate of annual UACR assessments was less than 50% in patients with type 2 DM. Therefore, it is not sufficient to predict mortality using a single-measurement of eGFR in patients with eGFR ≥ 60 mL/min/1.73 m 2, and other associated risk factors for mortality should be assessed in patients with type 2 DM without hypofiltration.
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An eGFR higher than the normal range might be associated with an increased risk of mortality in patients with type 2 DM. However, a meta-analysis reported that mortality risk was not linearly correlated with eGFR in individuals with an eGFR ≥ 60 mL/min/1.73 m 2. In particular, the stage of CKD is recommended to be defined using the eGFR value. Annual assessments of eGFR and urinary albumin-to-creatinine ratio (UACR) are recommended in the clinical management of patients with DM. Ī reduction in estimated glomerular filtration rate (eGFR), as well as the presence of albuminuria, is an independent predictor for mortality in patients with type 2 DM. Type 2 DM, the major type of DM, was responsible for more than 400 thousand deaths of CKD and was reported to be the second leading cause of CKD-related death in 2019. As the number of people with DM has been increasing worldwide, DM has become the most important cause of new-onset CKD. The global prevalence of CKD between stages 3 and 5 was reported to be approximately 10.6%, and diabetes mellitus (DM) is a major risk factor for CKD. According to the systematic analysis of the Global Burden of Disease Study, approximately 1.23 million people died from CKD in 2017, and the global all-age mortality rate for CKD increased by 41.5% between 19. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR 60 mL/min/1.73 m 2.Ĭhronic kidney disease (CKD) is a critical risk factor for death. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. In this retrospective cohort study, we enrolled patients with eGFR data between and 31 July 2018. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM.
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Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM.
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The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality.