TY - JOUR
T1 - Trajectories of eGFR and risk of albuminuria in youth with type 2 diabetes
T2 - results from the TODAY cohort study
AU - for the TODAY Study Group
AU - El ghormli, Laure
AU - Wen, Hui
AU - Uschner, Diane
AU - Haymond, Morey W.
AU - Hughan, Kara S.
AU - Kutney, Katherine
AU - Laffel, Lori
AU - Tollefsen, Sherida E.
AU - Escaname, Elia N.
AU - Lynch, Jane
AU - Bjornstad, Petter
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to International Pediatric Nephrology Association.
PY - 2023/12
Y1 - 2023/12
N2 - Background: We conducted exploratory analyses to identify distinct trajectories of estimated glomerular filtration rate (eGFR) and their relationship with hyperfiltration, subsequent rapid eGFR decline, and albuminuria in participants with youth-onset type 2 diabetes enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods: Annual serum creatinine, cystatin C, urine albumin, and creatinine measurements were obtained from 377 participants followed for ≥ 10 years. Albuminuria and eGFR were calculated. Hyperfiltration peak is the greatest eGFR inflection point during follow-up. Latent class modeling was applied to identify distinct eGFR trajectories. Results: At baseline, participants’ mean age was 14 years, type 2 diabetes duration was 6 months, mean HbA1c was 6%, and mean eGFR was 120 ml/min/1.73 m2. Five eGFR trajectories associated with different rates of albuminuria were identified, including a “progressive increasing eGFR” group (10%), three “stable eGFR” groups with varying starting mean eGFR, and an “eGFR steady decline” group (1%). Participants who exhibited the greatest peak eGFR also had the highest levels of elevated albuminuria at year 10. This group membership was characterized by a greater proportion of female and Hispanic participants. Conclusions: Distinct eGFR trajectories that associate with albuminuria risk were identified, with the eGFR trajectory characterized by increasing eGFR over time associating with the highest level of albuminuria. These descriptive data support the current recommendations to estimate GFR annually in young persons with type 2 diabetes and provide insight into eGFR-related factors which may contribute to predictive risk strategies for kidney disease therapies in youth with type 2 diabetes. Trial registration: ClinicalTrials.gov Identifier: NCT00081328, date registered 2002. Graphical abstract: [Figure not available: see fulltext.].
AB - Background: We conducted exploratory analyses to identify distinct trajectories of estimated glomerular filtration rate (eGFR) and their relationship with hyperfiltration, subsequent rapid eGFR decline, and albuminuria in participants with youth-onset type 2 diabetes enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Methods: Annual serum creatinine, cystatin C, urine albumin, and creatinine measurements were obtained from 377 participants followed for ≥ 10 years. Albuminuria and eGFR were calculated. Hyperfiltration peak is the greatest eGFR inflection point during follow-up. Latent class modeling was applied to identify distinct eGFR trajectories. Results: At baseline, participants’ mean age was 14 years, type 2 diabetes duration was 6 months, mean HbA1c was 6%, and mean eGFR was 120 ml/min/1.73 m2. Five eGFR trajectories associated with different rates of albuminuria were identified, including a “progressive increasing eGFR” group (10%), three “stable eGFR” groups with varying starting mean eGFR, and an “eGFR steady decline” group (1%). Participants who exhibited the greatest peak eGFR also had the highest levels of elevated albuminuria at year 10. This group membership was characterized by a greater proportion of female and Hispanic participants. Conclusions: Distinct eGFR trajectories that associate with albuminuria risk were identified, with the eGFR trajectory characterized by increasing eGFR over time associating with the highest level of albuminuria. These descriptive data support the current recommendations to estimate GFR annually in young persons with type 2 diabetes and provide insight into eGFR-related factors which may contribute to predictive risk strategies for kidney disease therapies in youth with type 2 diabetes. Trial registration: ClinicalTrials.gov Identifier: NCT00081328, date registered 2002. Graphical abstract: [Figure not available: see fulltext.].
KW - Albuminuria
KW - Diabetic kidney disease
KW - Glomerular filtration rate
KW - Hyperfiltration
KW - Trajectories
KW - Type 2 diabetes
KW - Youth
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U2 - 10.1007/s00467-023-06044-3
DO - 10.1007/s00467-023-06044-3
M3 - Article
C2 - 37434027
AN - SCOPUS:85164781675
SN - 0931-041X
VL - 38
SP - 4137
EP - 4144
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 12
ER -