The relationship between acute kidney injury and chronic kidney disease in patients with Type 2 Diabetes: an observational cohort study

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Abstract

Background: Type 2 diabetes is one of the leading causes of chronic kidney disease (CKD) and an independent risk factor for Acute Kidney Injury (AKI). This study aims to evaluate rates of AKI and how this relates to CKD status and further renal function decline in patients with and without type 2 diabetes using electronic healthcare records.

Methods: Study design was a retrospective cohort study. The negative-binomial model for counts with follow-up time as offset, adjusted for sex and age was used to evaluate AKI rates in people with and without diabetes depending on CKD status. A mixed effect linear model adjusted for demographic characteristics and co-morbidities was developed to evaluate decline in glomerular filtration rate (GFR) before and after an AKI event depending on diabetes and CKD status.

Results: The cohort was formed of 16700 participants with a median follow-up of 8.2 years. 9417 of these had type 2 diabetes and 7283 had no diabetes. 48.6% (N=4580) of participants with diabetes developed AKI compared to 17.2% (N=1257) of controls. 46.3% (N=4359) of those with diabetes had CKD vs 17.1% (N=1251) of controls. In the absence of CKD, AKI rate was five times higher in people with diabetes than controls (121.5 vs 24.6 per 1000 person-years, Rate Ratio RR=4.9, 95% CI 4.4-5.5), whereas for people with CKD, rate of AKI was twice higher in people with diabetes than controls (384.8 vs 180.0 per 1000 person-years, RR=2.1, 95% CI 1.9-2.4 after CKD date and 109.3 vs 47.4 per 1000 person-years, RR=2.3, 95% CI 1.8-3.0 prior to CKD). Fall in eGFR slope before AKI was steeper in people with diabetes compared to those without diabetes. After AKI episodes, loss of eGFR became steeper in people without diabetes, but did not increase in those with diabetes and pre-existing CKD.

Conclusion: Rates of AKI are significantly higher in patients with diabetes compared to patients without diabetes, and this remains true for individuals with pre-existing CKD.
Original languageEnglish
Number of pages25
JournalJournal of the American Society of Nephrology
Early online date18 Sep 2020
DOIs
Publication statusE-pub ahead of print - 18 Sep 2020

Keywords

  • acute kidney injury
  • chronic kidney disease
  • type 2 diabetes
  • epidemiology
  • incidence

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