Ethnicity, younger age linked to adverse outcomes in diabetic kidney disease
medwireNews: Ethnicity is associated with declining renal function and mortality risk among patients with diabetic kidney disease, and younger patients have the highest risk for rapid disease progression, researchers report.
“Ethnic minority groups are known to have a higher prevalence of [type 2 diabetes] and end-stage renal failure” than the White population, but whether this is due to faster progression of chronic kidney disease (CKD) “remains poorly understood,” say Sally Hull (Queen Mary University of London, UK) and study co-authors.
The team analyzed data from 6274 UK adults aged 25–84 years with type 2 diabetes and CKD who were free from end-stage renal failure at baseline, finding that the overall annual rate of estimated glomerular filtration rate (eGFR) decline over a median 9 years of follow-up was 0.86 mL/min per 1.73 m2 after adjustment for age and sex.
Relative to the 2447 White patients, the 2732 patients of South Asian ethnicity had a significantly faster rate of eGFR decline, whereas the 1095 Black patients had a significantly slower rate. Bangladeshi patients had the fastest annual rate of eGFR decline.
Despite being at increased risk for worsening kidney function, patients of South Asian ethnicity had a significant 29% lower risk for death than the White population, whereas there was no difference in mortality risk between Black and White patients.
Black patients, however, had the highest rate of rapid disease progression – defined as an annual decline in eGFR rate of at least 5 mL/min per 1.73 m2 – at 6.8%, compared with 4.9% for South Asian patients and 3.4% for White patients. In a multivariable analysis, African patients had a significant 2.5-fold higher risk for rapid progression than White patients, while Caribbean patients had a 1.6-fold increased risk. Moreover, Black patients were more than twice as likely as White patients to experience end-stage renal failure.
Hull and colleagues also found that, relative to patients aged 65–74 years, those aged 25–54 years had an almost twofold increased risk for rapid progression. Patients aged 55–64 years also had a numerically higher risk, but the difference did not reach statistical significance.
Younger adults, “who have greater odds of rapid progression and the most to gain from interventions,” therefore require “closer monitoring, management of risk factors and early specialist review to delay progression,” conclude the researchers in BMJ Open.
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