Can eGFR Slope Predict T2D Complications?

Approximately 40% of patients with type 2 diabetes (T2D) have diabetic kidney disease (DKD). DKD is associated with increased mortality and a higher risk of end-stage renal disease (ESRD) and cardiovascular (CV) events.

Estimated glomerular filtration rate (eGFR) slope is starting to generate clinical interest as an indicator of decline in kidney function. Giovanni Sartore, MD, and others undertook a systematic literature review and data meta-analysis to evaluate the associations among the decline of eGFR slope, chronic complications, and mortality of patients with T2D to better understand whether eGFR slope is a predictor of T2D complications. Their results appeared in the Journal of Diabetes Research.

The team searched for published studies on patients with T2D from January 2003 to April 2023 using PubMed and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To be included in the analysis, studies had to be clinical trials focusing on adult patients with T2D, investigating the measurement of the variability of the eGFR slope evaluated by hazard ratio (HR), using logistic or Cox regression analysis for outcome risk prediction, and having an outcome of risk of macrovascular/microvascular complications, all causes of death.

A total of 15 studies were chosen for meta-analysis. Risk analysis as HR determined there was a significant association among all considered events of interest (all-cause mortality, CV events, ESRD, and microvascular events) for patients with greater eGFR slope decline versus those with stable eGFR. Calculated HRs (95% CI) were 2.31 (1.70-3.15) for all-cause mortality, 1.73 (1.43-2.08) for CV events, 1.54 (1.45-1.64) for ESRD, and 2.07 (1.57-2.73) for microvascular events. Overall HR was 1.82 (1.72-1.92).

In sum, the researchers found an association between rapid eGFR decline and chronic T2D complications. This finding suggests that eGFR slope significantly impacts the course of T2D and should be considered as a predictor of chronic complications in patients with T2D.

“This assumption opens important future perspectives in the field of the care of [T2D] patients, but also of the early diagnosis of diabetes complications, considering the impact that these have on patient mortality,” the authors wrote. The results also indicate that management of patients with diabetes should not focus solely on controlling blood sugar; attention should also be paid to preserving kidney function.

Source: Journal of Diabetes Research