Probability of progression and regression of chronic kidney disease in patients with type 2 diabetes mellitus

Abstract

Objectives

To examine the annual transitions between the stages of diabetic kidney disease (DKD) in an Asian population with type 2 diabetes.

Study design

Longitudinal cohort study.

Main outcome measures

We analysed 15,913 clinic visits by 5980 patients (Chinese, Malay and Indian) who attended at least 2 annual primary care visits from 2010 to 2015, with DKD categorised into G1-G5 stages by estimated glomerular filtration rate. We applied a multistate Markov model adjusting for risk factors to estimate annual transition probabilities and sojourn times.

Results

Median (interquartile range) follow-up duration was 2.01 (1.11–2.93) years. Annual transition probabilities of progression from G1-G2 to G3 and G3 to G4-G5 were 1.26 % and 1.21 % respectively. Annual death rates among the G1-G2, G3 and G4-G5 groups were 0.92 %, 1.63 %, and 5.84 %, respectively. Estimated sojourn times in the G1-G2, G3 and G4-G5 groups were 43.73, 6.97, and 6.32 years, respectively. Among modifiable risk factors, progression from G1-G2 to G3 was associated with higher systolic blood pressure while death was associated with the presence of diabetic retinopathy, higher hemoglobin A1_c (HbA1c) and lower body mass index.

Conclusions

Annual DKD progression in this screened population was slow but death from advanced stages was high. Ongoing surveillance and targeted control of risk factors such as blood pressure, HbA1c, and diabetic retinopathy may help improve outcomes.