MP260KIDNEY FUNCTION DECLINE IN OUTPATIENT DIABETES MELLITUS TYPE 2 (DM2): THE DIABETES COHORTE (DIACORE)

Abstract

Introduction and Aims: DM2 associated CKD (DKD) is an important cause of ESRD in spite of modern risk factor management. Understanding the natural history of kidney function decline and incidence of DKD is key to identifying subgroups at highest risk, but has not been studied in large representative observational studies. We investigated the association of treatable cardiovascular risk factors with kidney function decline traits in DIACORE. Methods: DIACORE is a fully recruited, prospective, observational, two-center cohort study of 3000 DM2 patients. Inclusion criteria: adult Caucasian with DM2 in outpatient care at a general practicioner. Key exclusion criteria at baseline: renal replacement therapy, autoimmune disease with potential renal disease. We measured serum creatinine with the same IDMS-traceable enzymatic creatinine assay on a Roche platform at baseline and at the 1st follow up visit. GFR was estimated using the creatinine based CKD-EPI formula and used to calculate 5 eGFR decline traits: KDIGO definitions of CKD progression (CKDi25: incident CKD with >=25% drop in eGFR; Rapid5: sustained decline in eGFR >5ml/min/1.73m2 per year), FDA-approved renal end points (>57% eGFR decline; >40% eGFR decline), and annual eGFR decline. In multivariate analysis, baseline HbA1c, blood pressure, waist-hip-ratio (WHR), LDL, HDL and active smoking were evaluated as predictors of eGFR decline traits, adjusted for baseline age, DM2 duration, eGFR, and albuminuria >30mg/g, sex and newly initiated RAAS blockade between inclusion and follow-up visit. Data are provided as mean (SD). Results: Baseline characteristics of the 2276 patients that completed the ongoing first follow-up examination by December 2015 and had GFR estimates at both visits were: 61.3% males, age: 64.9(8.9) yrs, duration of diabetes: 10.0(8.2) yrs, HbA1c 6.9% RR 139/77 mmHg WHR 0.96(0.1). During the follow-up of 2.9(0.8) years, eGFR declined 1.9(4.5) ml/min/1.73m2 per year from a baseline eGFR of 79.6(19.1) ml/min/1.73m2. At follow-up, >57% eGFR decline, >40% eGFR decline, CKDi25 and Rapid5 occurred in 14 (0.6%), 63 (2.8%), 127 (7.1%) and 394 (17.3%) patients, respectively. Higher baseline HbA1c and systolic blood pressure was associated with a significantly higher risk of all 5 traits studied in multivariate analysis (Table 1). Baseline eGFR and albuminuria >30mg/g had independent significant effects on most traits (Table 1). The other variables tested had no effect on eGFR decline phenotypes. Conclusions: In this representative outpatient DM2 cohort with mean HbA1c and blood pressure within current treatment goals, elevated HbA1c and systolic blood pressure are the only treatable cardiovascular risk factors significantly associated with 5 different renal traits in prospective analysis. (Table Presented).