The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

• Published in: Journal of the American Society of Nephrology Vol. 32; no. 1; pp. 138 - 150
• Main Authors: Hapca, Simona, Siddiqui, Moneeza K, Kwan, Ryan S Y, Lim, Michelle, Matthew, Shona, Doney, Alex S F, Pearson, Ewan R, Palmer, Colin N A, Bell, Samira
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.01.2021
• Subjects: Acute Kidney Injury - complications; Adult; Aged; Algorithms; Clinical Epidemiology; Creatinine - blood; Diabetes Mellitus, Type 2 - complications; Disease Progression; Electronic Health Records; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Male; Middle Aged; Renal Insufficiency, Chronic - complications; Retrospective Studies; Risk Factors; Scotland; Treatment Outcome; Scotland; chronic kidney disease; epidemiology and outcomes; acute kidney injury; diabetes mellitus
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2020030323

There are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population. In this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline. We followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD. Patients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.