Rate and risk factors of kidney function decline among South Asians with type 2 diabetes: analysis of the CARRS Trial.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-08-16 DOI:10.1136/bmjdrc-2024-004218
Kavita Singh, Dimple Kondal, Ram Jagannathan, Mohammed K Ali, Dorairaj Prabhakaran, K M Venkat Narayan, Shuchi Anand, Nikhil Tandon
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Abstract

Introduction: People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia.

Research design and methods: We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site.

Results: The mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was -1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: -2.11; 95% CI: -3.45 to -0.77), previous cardiovascular disease (-1.93; 95% CI: -3.45 to -0.40), and statins use (-0.87; 95% CI: -1.65 to -0.10) were associated with faster eGFR decline.

Conclusions: People with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications.

Trial registration number: NCT01212328.

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南亚裔 2 型糖尿病患者肾功能下降的速度和风险因素:CARRS 试验分析。
引言糖尿病患者有罹患慢性肾病的风险。然而,在南亚地区,量化其肾功能衰退风险的数据十分有限。本研究评估了南亚 2 型糖尿病患者肾功能衰退的比率和预测因素:我们分析了南亚降低心脏代谢风险中心(CARRS)试验的数据,以量化 2.5 年随访期间 2 型糖尿病患者(1146 人)估计肾小球滤过率(eGFR)的下降率。CARRS 试验评估了印度和巴基斯坦 10 家糖尿病诊所为改善糖尿病管理而采取的决策支持型电子健康记录和非医生护理协调员的多成分干预措施。我们使用线性混合模型估算了所有参与者的 eGFR 斜率,并检验了 eGFR 斜率与人口统计学、疾病相关参数和自我护理参数的关系,同时考虑了随机化和地点因素:参与者的平均年龄为 54.2 岁,中位糖尿病病程为 7.0 年(IQR:3.0 - 12.0),中位 CKD-EPI(慢性肾脏病流行病学协作组)eGFR 为 83.6(IQR:67.7 - 97.9) mL/min/1.73 m2。总体平均 eGFR 斜率为-1.33/毫升/分钟/1.73 m2/年。干预治疗与常规治疗的eGFR斜率没有差异。在调整回归模型中,既往糖尿病视网膜病变(斜率差异:-2.11;95% CI:-3.45 至 -0.77)、既往心血管疾病(-1.93;95% CI:-3.45 至 -0.40)和他汀类药物的使用(-0.87;95% CI:-1.65 至 -0.10)与 eGFR 下降较快有关联:结论:在南亚城市糖尿病诊所接受治疗的糖尿病患者每年的 eGFR 下降率是其他当代国际糖尿病队列报告的两倍。导致下降速度加快的风险因素与之前确定的因素相似,因此护理模式必须更加重视对患有微血管和大血管糖尿病并发症的亚组进行肾脏保护治疗:NCT01212328.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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