The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: The Fremantle diabetes study

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    Abstract

    © 2016 European Society of Endocrinology Printed in Great Britain.Objective: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. Design: Longitudinal observational study. Methods: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. Results: In the full cohort (1296 patients; mean ± s.d. age 64.1 ± 11.3 years, 48.6% males), 738 (56.9%) died during 12.9 ± 6.1 years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59 mL/min/1.73 m2) as reference, the strongest association was for eGFR =90 mL/min/1.73 m2 (hazard ratio (95% CI) 2.01 (1.52-2.66); P <0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P = 0.003) and associated median reductions in survival of 6.5 and 8.7 years respectively. Conclusion: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.
    Original languageEnglish
    Pages (from-to)273-285
    Number of pages13
    JournalEuropean Journal of Endocrinology
    Volume175
    Issue number4
    Early online date14 Jul 2016
    DOIs
    Publication statusPublished - 1 Oct 2016

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    Glomerular Filtration Rate
    Type 2 Diabetes Mellitus
    Mortality
    Cause of Death
    Observational Studies
    Longitudinal Studies
    Survival

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    @article{92bcba06abdd4dd1b970d7fe3c2e26fe,
    title = "The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: The Fremantle diabetes study",
    abstract = "{\circledC} 2016 European Society of Endocrinology Printed in Great Britain.Objective: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. Design: Longitudinal observational study. Methods: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. Results: In the full cohort (1296 patients; mean ± s.d. age 64.1 ± 11.3 years, 48.6{\%} males), 738 (56.9{\%}) died during 12.9 ± 6.1 years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59 mL/min/1.73 m2) as reference, the strongest association was for eGFR =90 mL/min/1.73 m2 (hazard ratio (95{\%} CI) 2.01 (1.52-2.66); P <0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P = 0.003) and associated median reductions in survival of 6.5 and 8.7 years respectively. Conclusion: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.",
    author = "Timothy Davis and Paul Chubb and Wendy Davis",
    year = "2016",
    month = "10",
    day = "1",
    doi = "10.1530/EJE-16-0327",
    language = "English",
    volume = "175",
    pages = "273--285",
    journal = "European Journal of Endocrinology,",
    issn = "0804-4643",
    publisher = "BioScientifica Ltd",
    number = "4",

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    TY - JOUR

    T1 - The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: The Fremantle diabetes study

    AU - Davis, Timothy

    AU - Chubb, Paul

    AU - Davis, Wendy

    PY - 2016/10/1

    Y1 - 2016/10/1

    N2 - © 2016 European Society of Endocrinology Printed in Great Britain.Objective: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. Design: Longitudinal observational study. Methods: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. Results: In the full cohort (1296 patients; mean ± s.d. age 64.1 ± 11.3 years, 48.6% males), 738 (56.9%) died during 12.9 ± 6.1 years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59 mL/min/1.73 m2) as reference, the strongest association was for eGFR =90 mL/min/1.73 m2 (hazard ratio (95% CI) 2.01 (1.52-2.66); P <0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P = 0.003) and associated median reductions in survival of 6.5 and 8.7 years respectively. Conclusion: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.

    AB - © 2016 European Society of Endocrinology Printed in Great Britain.Objective: To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. Design: Longitudinal observational study. Methods: Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. Results: In the full cohort (1296 patients; mean ± s.d. age 64.1 ± 11.3 years, 48.6% males), 738 (56.9%) died during 12.9 ± 6.1 years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59 mL/min/1.73 m2) as reference, the strongest association was for eGFR =90 mL/min/1.73 m2 (hazard ratio (95% CI) 2.01 (1.52-2.66); P <0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P = 0.003) and associated median reductions in survival of 6.5 and 8.7 years respectively. Conclusion: There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.

    U2 - 10.1530/EJE-16-0327

    DO - 10.1530/EJE-16-0327

    M3 - Article

    VL - 175

    SP - 273

    EP - 285

    JO - European Journal of Endocrinology,

    JF - European Journal of Endocrinology,

    SN - 0804-4643

    IS - 4

    ER -