Independently and together, changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) predict the risk of kidney and cardiovascular events and death in patients with type 2 diabetes, reports a study in a recent issue of CJASN.
“Our overall results suggest that a combined approach of determining clinically meaningful magnitudes of earlier change in both eGFR and UACR in type 2 diabetes may add substantial prognostic value to that associated with eGFR or albuminuria change alone,” concludes the report by John Chalmers, MD, PhD, of The George Institute for Global Health, University of New South Wales, Camperdown, Australia.
Based on 10-year follow-up data of nearly 9000 patients from an international randomized trial, the study suggests that assessing kidney function and albuminuria in combination might not only provide valuable information for risk stratification. “These are very simple and very good markers,” Chalmers said. “The combination should be a more potent predictor of major outcomes, especially renal outcomes, than either marker alone.”
“This paper is a nice addition to the research literature, because it monitors the effects of changes in both eGFR and UACR,” commented Kunihiro Matsushita, MD, PhD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, and Director of the Chronic Kidney Disease Prognosis Consortium Data Coordinating Center.
“Although both markers have attracted attention in previous studies, this paper evaluates changes in both eGFR and UACR in the same patient population,” Matsushita added. “In terms of risk prediction, assessing changes in eGFR and UACR may provide additional information beyond the baseline values.”
Toshiaki Ohkuma, MD, PhD, of The George Institute, is lead author of the new report, on behalf of the ADVANCE Collaborative Group. Additional coauthors are Min Jun, Mark E. Cooper, Pavel Hamet, Stephen Harrap, Sophia Zoungas, Vlado Perkovic, and Mark Woodward (https://doi.org/10.2215/CJN.13391118).
Jun M, et al.. ADVANCE Collaborative Group. Changes in albuminuria and the risk of major clinical outcomes in diabetes: Results from ADVANCE-ON. Diabetes Care 2018; 41:163–170.
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