Kidney Outcomes in Patients With Nonalbuminuric DKD

Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype of DKD. Qiao Jin, MSc, and colleagues, including representatives from the Hong Kong Diabetes Biobank Study Group, conducted a multicenter prospective cohort study designed to compare the risk of adverse outcomes among patients with nonalbuminuric DKD versus patients with other DKD phenotypes. Results were reported in the American Journal of Kidney Diseases [2022;80(2):196-206]

Participants were 19 025 Chinese adults with type 2 diabetes who were enrolled in the Hong Kong Diabetes Biobank. The outcomes of interest were all-cause mortality, cardiovascular disease events, hospitalization for heart failure, and progression of chronic kidney disease, defined as incident kidney failure or sustained reduction in estimated glomerular filtration rate (eGFR) ≥40%

The relative risks of death, cardiovascular disease, hospitalization for heart failure, and CKD progression were estimated using multivariable Cox proportional or cause-specific hazards models; multiple imputation was used for missing covariates.

Mean age was 61.1 years, 58.3% were male, and mean duration of diabetes was 11.1 years. During 54,260 person-years of follow-up, there were 438 deaths, 1076 cardiovascular disease events, 298 hospitalizations for heart failure, and 1161 episodes of CKD progression. Compared with the subgroup without DKD, the subgroup with decreased eGFR without albuminuria had increased risks of all-cause mortality (hazard ratio [HR], 1.59; 95% CI, 1.04-2.44), hospitalization for heart failure (HR, 3.08; 95% CI, 1.82-5.21), and progression of CKD (HR, 2.37; 95% CI, 1.63-3.43); there was no significant difference in the risk of cardiovascular disease.

Among participants with albuminuria with or without decreased eGFR, the risks of death, cardiovascular disease, hospitalization for heart failure, and progression of CKD were higher.

In conclusion, the authors said, “Nonalbuminuric DKD was associated with higher risks of hospitalization for heart failure and of CKD progression than no DKD, regardless of baseline eGFR.”