Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

Qiao Jin; Andrea O. Luk; Eric S.H. Lau; Claudia H.T. Tam; Risa Ozaki; Cadmon K.P. Lim; Hongjiang Wu; Guozhi Jiang; Elaine Y.K. Chow; Jack K. Ng; Alice P.S. Kong; Baoqi Fan; Ka Fai Lee; Shing Chung Siu; Grace Hui; Chiu Chi Tsang; Kam Piu Lau; Jenny Y. Leung; Man-wo Tsang; Grace Kam; Ip Tim Lau; June K. Li; Vincent T. Yeung; Emmy Lau; Stanley Lo; Samuel Fung; Yuk Lun Cheng; Chun Chung Chow; Yu Huang; Hui-yao Lan; Cheuk Chun Szeto; Wing Yee So; Juliana C.N. Chan; Ronald C.W. Ma; on behalf of the Hong Kong Diabetes Biobank Study Group

doi:10.1053/j.ajkd.2021.11.011

Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

Qiao Jin, Andrea O. Luk, Eric S.H. Lau, Claudia H.T. Tam, Risa Ozaki, Cadmon K.P. Lim, Hongjiang Wu, Guozhi Jiang, Elaine Y.K. Chow, Jack K. Ng, Alice P.S. Kong, Baoqi Fan, Ka Fai Lee, Shing Chung Siu, Grace Hui, Chiu Chi Tsang, Kam Piu Lau, Jenny Y. Leung, Man-wo Tsang, Grace KamIp Tim Lau, June K. Li, Vincent T. Yeung, Emmy Lau, Stanley Lo, Samuel Fung, Yuk Lun Cheng, Chun Chung Chow, Yu Huang, Hui-yao Lan, Cheuk Chun Szeto, Wing Yee So, Juliana C.N. Chan, Ronald C.W. Ma^*, on behalf of the Hong Kong Diabetes Biobank Study Group

^*Corresponding author for this work

Department of Biomedical Sciences

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

43 Citations (Scopus)

71 Downloads (CityUHK Scholars)

Abstract

Rationale & Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes.

Study Design: Multicenter prospective cohort study.

Settings & Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank.

Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR.

Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%).

Analytical Approach: Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates.

Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m² yielded similar findings.

Limitations: Potential misclassification because of drug use.

Conclusions: Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.

Original language	English
Pages (from-to)	196-206.e1
Journal	American Journal of Kidney Diseases
Volume	80
Issue number	2
Online published	6 Jan 2022
DOIs	https://doi.org/10.1053/j.ajkd.2021.11.011
Publication status	Published - Aug 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Keywords

albuminuria
cardiovascular disease (CVD)
chronic kidney disease (CKD)
CKD progression
Diabetic kidney disease (DKD)
estimated glomerular filtration rate (eGFR)
hospitalization for heart failure (HHF)
kidney failure
mortality
nonalbuminuric DKD
phenotype
prognosis
type 2 diabetes
type 2 diabetes (T2D)
urinary albumin-creatinine ratio (UACR)

Publisher's Copyright Statement

This full text is made available under CC-BY-NC-ND 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/

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10.1053/j.ajkd.2021.11.011

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Jin, Q., Luk, A. O., Lau, E. S. H., Tam, C. H. T., Ozaki, R., Lim, C. K. P., Wu, H., Jiang, G., Chow, E. Y. K., Ng, J. K., Kong, A. P. S., Fan, B., Lee, K. F., Siu, S. C., Hui, G., Tsang, C. C., Lau, K. P., Leung, J. Y., Tsang, M., ... on behalf of the Hong Kong Diabetes Biobank Study Group (2022). Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank. American Journal of Kidney Diseases, 80(2), 196-206.e1. https://doi.org/10.1053/j.ajkd.2021.11.011

@article{19df33a43cb844ffa0d356d1be8817e3,

title = "Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank",

abstract = "Rationale & Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes. Study Design: Multicenter prospective cohort study. Settings & Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR. Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%). Analytical Approach: Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates. Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m2 yielded similar findings. Limitations: Potential misclassification because of drug use. Conclusions: Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.",

keywords = "albuminuria, cardiovascular disease (CVD), chronic kidney disease (CKD), CKD progression, Diabetic kidney disease (DKD), estimated glomerular filtration rate (eGFR), hospitalization for heart failure (HHF), kidney failure, mortality, nonalbuminuric DKD, phenotype, prognosis, type 2 diabetes, type 2 diabetes (T2D), urinary albumin-creatinine ratio (UACR)",

author = "Qiao Jin and Luk, {Andrea O.} and Lau, {Eric S.H.} and Tam, {Claudia H.T.} and Risa Ozaki and Lim, {Cadmon K.P.} and Hongjiang Wu and Guozhi Jiang and Chow, {Elaine Y.K.} and Ng, {Jack K.} and Kong, {Alice P.S.} and Baoqi Fan and Lee, {Ka Fai} and Siu, {Shing Chung} and Grace Hui and Tsang, {Chiu Chi} and Lau, {Kam Piu} and Leung, {Jenny Y.} and Man-wo Tsang and Grace Kam and Lau, {Ip Tim} and Li, {June K.} and Yeung, {Vincent T.} and Emmy Lau and Stanley Lo and Samuel Fung and Cheng, {Yuk Lun} and Chow, {Chun Chung} and Yu Huang and Hui-yao Lan and Szeto, {Cheuk Chun} and So, {Wing Yee} and Chan, {Juliana C.N.} and Ma, {Ronald C.W.} and {on behalf of the Hong Kong Diabetes Biobank Study Group} and {Poo Lim}, {Cadmon King} and Leung, {Jenny Y.Y.} and Tsang, {Man Wo} and Elaine Cheung and Li, {June Kam-yin} and Yeung, {Vincent T.F.} and Fung, {Samuel K.S.} and Tsui, {Stephen Kwok-wing} and Weichuan Yu and Brian Tomlinson and Si Lok and Chan, {Ting Fung} and Yip, {Kevin Yuk-lap} and Xiaodan Fan and Tang, {Nelson L.S.} and Xiaoyu Tian",

year = "2022",

month = aug,

doi = "10.1053/j.ajkd.2021.11.011",

language = "English",

volume = "80",

pages = "196--206.e1",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders",

number = "2",

}

Jin, Q, Luk, AO, Lau, ESH, Tam, CHT, Ozaki, R, Lim, CKP, Wu, H, Jiang, G, Chow, EYK, Ng, JK, Kong, APS, Fan, B, Lee, KF, Siu, SC, Hui, G, Tsang, CC, Lau, KP, Leung, JY, Tsang, M, Kam, G, Lau, IT, Li, JK, Yeung, VT, Lau, E, Lo, S, Fung, S, Cheng, YL, Chow, CC, Huang, Y, Lan, H, Szeto, CC, So, WY, Chan, JCN, Ma, RCW & on behalf of the Hong Kong Diabetes Biobank Study Group 2022, 'Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank', American Journal of Kidney Diseases, vol. 80, no. 2, pp. 196-206.e1. https://doi.org/10.1053/j.ajkd.2021.11.011

Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank. / Jin, Qiao; Luk, Andrea O.; Lau, Eric S.H. et al.
In: American Journal of Kidney Diseases, Vol. 80, No. 2, 08.2022, p. 196-206.e1.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes

T2 - Findings From the Hong Kong Diabetes Biobank

AU - Jin, Qiao

AU - Luk, Andrea O.

AU - Lau, Eric S.H.

AU - Tam, Claudia H.T.

AU - Ozaki, Risa

AU - Lim, Cadmon K.P.

AU - Wu, Hongjiang

AU - Jiang, Guozhi

AU - Chow, Elaine Y.K.

AU - Ng, Jack K.

AU - Kong, Alice P.S.

AU - Fan, Baoqi

AU - Lee, Ka Fai

AU - Siu, Shing Chung

AU - Hui, Grace

AU - Tsang, Chiu Chi

AU - Lau, Kam Piu

AU - Leung, Jenny Y.

AU - Tsang, Man-wo

AU - Kam, Grace

AU - Lau, Ip Tim

AU - Li, June K.

AU - Yeung, Vincent T.

AU - Lau, Emmy

AU - Lo, Stanley

AU - Fung, Samuel

AU - Cheng, Yuk Lun

AU - Chow, Chun Chung

AU - Huang, Yu

AU - Lan, Hui-yao

AU - Szeto, Cheuk Chun

AU - So, Wing Yee

AU - Chan, Juliana C.N.

AU - Ma, Ronald C.W.

AU - on behalf of the Hong Kong Diabetes Biobank Study Group

AU - Poo Lim, Cadmon King

AU - Leung, Jenny Y.Y.

AU - Tsang, Man Wo

AU - Cheung, Elaine

AU - Li, June Kam-yin

AU - Yeung, Vincent T.F.

AU - Fung, Samuel K.S.

AU - Tsui, Stephen Kwok-wing

AU - Yu, Weichuan

AU - Tomlinson, Brian

AU - Lok, Si

AU - Chan, Ting Fung

AU - Yip, Kevin Yuk-lap

AU - Fan, Xiaodan

AU - Tang, Nelson L.S.

AU - Tian, Xiaoyu

PY - 2022/8

Y1 - 2022/8

N2 - Rationale & Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes. Study Design: Multicenter prospective cohort study. Settings & Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR. Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%). Analytical Approach: Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates. Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m2 yielded similar findings. Limitations: Potential misclassification because of drug use. Conclusions: Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.

AB - Rationale & Objective: Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing DKD phenotype. We compared the risks of adverse outcomes among patients with this phenotype compared with other DKD phenotypes. Study Design: Multicenter prospective cohort study. Settings & Participants: 19,025 Chinese adults with type 2 diabetes enrolled in the Hong Kong Diabetes Biobank. Exposures: DKD phenotypes defined by baseline estimated glomerular filtration rate (eGFR) and albuminuria: no DKD (no decreased eGFR or albuminuria), albuminuria without decreased eGFR, decreased eGFR without albuminuria, and albuminuria with decreased eGFR. Outcomes: All-cause mortality, cardiovascular disease (CVD) events, hospitalization for heart failure (HF), and chronic kidney disease (CKD) progression (incident kidney failure or sustained eGFR reduction ≥40%). Analytical Approach: Multivariable Cox proportional or cause-specific hazards models to estimate the relative risks of death, CVD, hospitalization for HF, and CKD progression. Multiple imputation was used for missing covariates. Results: Mean participant age was 61.1 years, 58.3% were male, and mean diabetes duration was 11.1 years. During 54,260 person-years of follow-up, 438 deaths, 1,076 CVD events, 298 hospitalizations for HF, and 1,161 episodes of CKD progression occurred. Compared with the no-DKD subgroup, the subgroup with decreased eGFR without albuminuria had higher risks of all-cause mortality (hazard ratio [HR], 1.59 [95% CI, 1.04-2.44]), hospitalization for HF (HR, 3.08 [95% CI, 1.82-5.21]), and CKD progression (HR, 2.37 [95% CI, 1.63-3.43]), but the risk of CVD was not significantly greater (HR, 1.14 [95% CI, 0.88-1.48]). The risks of death, CVD, hospitalization for HF, and CKD progression were higher in the setting of albuminuria with or without decreased eGFR. A sensitivity analysis that excluded participants with baseline eGFR <30 mL/min/1.73 m2 yielded similar findings. Limitations: Potential misclassification because of drug use. Conclusions: Nonalbuminuric DKD was associated with higher risks of hospitalization for HF and of CKD progression than no DKD, regardless of baseline eGFR.

KW - albuminuria

KW - cardiovascular disease (CVD)

KW - chronic kidney disease (CKD)

KW - CKD progression

KW - Diabetic kidney disease (DKD)

KW - estimated glomerular filtration rate (eGFR)

KW - hospitalization for heart failure (HHF)

KW - kidney failure

KW - mortality

KW - nonalbuminuric DKD

KW - phenotype

KW - prognosis

KW - type 2 diabetes

KW - type 2 diabetes (T2D)

KW - urinary albumin-creatinine ratio (UACR)

UR - http://www.scopus.com/inward/record.url?scp=85132679494&partnerID=8YFLogxK

UR - https://www.scopus.com/record/pubmetrics.uri?eid=2-s2.0-85132679494&origin=recordpage

U2 - 10.1053/j.ajkd.2021.11.011

DO - 10.1053/j.ajkd.2021.11.011

M3 - RGC 21 - Publication in refereed journal

C2 - 34999159

SN - 0272-6386

VL - 80

SP - 196-206.e1

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

IS - 2

ER -

Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

Abstract

UN SDGs

Research Keywords

Publisher's Copyright Statement

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SRFS: Systemic Benefits of Physical Activity: Crosstalk between Organs on Signal Transduction from Mechano-stimulation to Metabolism

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Nonalbuminuric Diabetic Kidney Disease and Risk of All-Cause Mortality and Cardiovascular and Kidney Outcomes in Type 2 Diabetes: Findings From the Hong Kong Diabetes Biobank

Abstract

UN SDGs

Research Keywords

Publisher's Copyright Statement

Access Output

Other Access Options

Permanent Link

Other Files and Links

Fingerprint

Projects

SRFS: Systemic Benefits of Physical Activity: Crosstalk between Organs on Signal Transduction from Mechano-stimulation to Metabolism

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