Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

• DOI: 10.1053/j.ajkd.2021.11.011
• Publication Date: 2022-01-06T16:24:27Z
• Authors: Qiao Jin; Andrea O. Luk; Eric S.H. Lau; Claudia H.T. Tam; Risa Ozaki; Cadmon K.P. Lim; Hongjiang Wu; Guozhi Jiang; Elaine Y.K. Chow; Jack K. Ng; Alice P.S. Kong; Baoqi Fan; Ka Fai Lee; Shing Chung Siu; Grace Hui; Chiu Chi Tsang; Kam Piu Lau; Jenny Y. Leung; Man-wo Tsang; Grace Kam; Ip Tim Lau; June K. Li; Vincent T. Yeung; Emmy Lau; Stanley Lo; Samuel Fung; Yuk Lun Cheng; Chun Chung Chow; Yu Huang; Hui-yao Lan; Cheuk Chun Szeto; Wing Yee So; Juliana C.N. Chan; Ronald C.W. Ma; Ronald C.W. Ma; Juliana C.N. Chan; Risa Ozaki; Andrea O. Luk; Wing Yee So; Cadmon King Poo Lim; Ka Fai Lee; Shing Chung Siu; Grace Hui; Chiu Chi Tsang; Kam Piu Lau; Jenny Y.Y. Leung; Man Wo Tsang; Grace Kam; Elaine Cheung; Ip Tim Lau; June Kam-yin Li; Vincent T.F. Yeung; Samuel K.S. Fung; Stanley Lo; Emmy Lau; Yuk Lun Cheng; Stephen Kwok-wing...; Yu Huang; Hui-yao Lan; Weichuan Yu; Brian Tomlinson; Si Lok; Ting Fung Chan; Kevin Yuk-lap Yip; Cheuk Chun Szeto; Xiaodan Fan; Nelson L.S. Tang; Xiaoyu Tian; Claudia H.T. Tam; Guozhi Jiang; Shi Mai; Baoqi Fan; Eric S. Lau; Fei Xie; Sen Zhang; Pu Yu; Meng Wang; Heung Man Lee; Fangying Xie; Alex C.W. Ng; Grace Cheung; Alice P.S. Kong; Elaine Y.K. Chow; Ming Wai Yeung; Chun Chung Chow; Kitty K.T. Cheung; Rebecca Y.M. Wong; So Hon Cheong; Katie K.H. Chan; Chin-san Law; Anthea Ka Yuen Lock; Ingrid Kwok Ying ...; Susanna Chi Pun Chan; Yin Wah Chan; Cherry Chiu; Chi Sang Hung; Cheuk Wah Ho; Ivy Hoi Yee Ng; Juliana Mun Chun Fok; Kai Man Lee; Hoi Sze Candy Leung; Ka Wah Lee; Hui Ming Chan; Winnie Wat; Tracy Lau; Rebecca Law; Ryan Chan; Candice Lau; Pearl Tsang; Vince Chan; Lap Ying Ho; Eva Wong; Josephine Chan; Sau Fung Lam; Jessy Pang; Yee Mui Lee
• Keywords: Urinary albumin-creatinine ratio (UACR); Male; CKD progression; Hospitalization for heart failure (HHF); Kidney failure; 610; Chronic kidney disease (CKD); Kidney; 03 medical and health sciences; Nonalbuminuric DKD; 0302 clinical medicine; 616; Albuminuria; Humans; Diabetic Nephropathies; Prospective Studies; Mortality; Renal Insufficiency, Chronic; Type 2 diabetes (T2D); Biological Specimen Banks; Heart Failure; Cardiovascular disease (CVD); Type 2 diabetes; Prognosis; 3. Good health; Phenotype; Diabetes Mellitus, Type 2; Cardiovascular Diseases; Estimated glomerular filtration rate (eGFR); Hong Kong; Female; Diabetic kidney disease (DKD); Glomerular Filtration Rate

Rationale & ObjectiveNonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared risks of adverse outcomes among patients with this phenotype other phenotypes.Study DesignMulticenter prospective cohort study.Settings Participants19,025 Chinese adults type 2 diabetes enrolled in Hong Kong Diabetes Biobank.ExposuresDKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no (no decreased eGFR or albuminuria), albuminuria without eGFR, albuminuria, eGFR.OutcomesAll-cause mortality, cardiovascular (CVD) events, hospitalization for heart failure (HF), chronic (CKD) progression (incident sustained reduction ≥40%).Analytical ApproachMultivariable Cox proportional cause-specific hazards models to estimate relative death, CVD, HF, CKD progression. Multiple imputation was used missing covariates.ResultsMean participant age 61.1 years, 58.3% were male, mean duration 11.1 years. During 54,260 person-years follow-up, 438 deaths, 1,076 CVD 298 hospitalizations 1,161 episodes occurred. Compared no-DKD subgroup, subgroup had higher all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), HF (HR, 3.08 1.82-5.21]), 2.37 1.63-3.43]), but risk not significantly greater 1.14 0.88-1.48]). The setting eGFR. A sensitivity analysis that excluded participants <30 mL/min/1.73 m2 yielded similar findings.LimitationsPotential misclassification because drug use.ConclusionsNonalbuminuric associated than DKD, regardless Nonalbuminuric phenotypes. Multicenter study. 19,025 Biobank. All-cause ≥40%). Multivariable covariates. Mean findings. Potential use.