ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2013
The synergistic relationship between estimated GFR and microalbuminuria in predicting long-term progression to ESRD or death in patients with diabetes: results from the Kidney Early Evaluation Program (KEEP).
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 3 of them syntheses that pooled it.
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37 citing papers in PubMed, 3 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Mathematical expansion and clinical application of chronic kidney disease stage as vector field.PloS one · 2024Pooled it
- Characteristics predicting the efficacy of SGLT-2 inhibitors versus GLP-1 receptor agonists on major adverse cardiovascular events in type 2 diabetes mellitus: a meta-analysis study.Cardiovascular diabetology · 2023Pooled it
- Costs and Healthcare Resource Use Associated with Risk of Cardiovascular Morbidity in Patients with Chronic Kidney Disease: Evidence from a Systematic Literature Review.Advances in therapy · 2021Pooled it
- Cardiovascular and renal outcomes by baseline albuminuria status and renal function: Results from the LEADER randomized trial.Diabetes, obesity & metabolism · 2020Trial
- Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2019Trial
- Dual Antioxidant Supplementation With N-Acetylcysteine and Taurine (NefrosaveCardiology research · 2026Article
- Risk prediction model for progression of type 2 diabetic nephropathy with and without metabolic syndrome: a retrospective cohort study.Frontiers in endocrinology · 2025Article
- The significance of finerenone as a novel therapeutic option in diabetic kidney disease: a scoping review with emphasis on cardiorenal outcomes of the finerenone phase 3 trials.Frontiers in medicine · 2024Article
- The Cardiac-Kidney-Liver (CKL) syndrome: the "real entity" of type 2 diabetes mellitus.Archives of medical science : AMS · 2024Article
- Glomerular filtration rate in patients with type 2 diabetes mellitus: is serum isthmin-1 level a possible link?BMJ open diabetes research & care · 2023Article
- Prognostic significance of albuminuria in elderly of various ages with diabetes.Scientific reports · 2023Article
- Comparative Efficacy of Novel Antidiabetic Drugs on Albuminuria Outcomes in Type 2 Diabetes: A Systematic Review.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2023Review
- Renal Protection of Mineralocorticoid Receptor Antagonist, Finerenone, in Diabetic Kidney Disease.Endocrinology and metabolism (Seoul, Korea) · 2023Review
- Role of neutrophil-lymphocyte ratio as a prognostic marker for type 2 diabetic nephropathy among Indians.Bioinformation · 2023Article
- Synergistic effect of chronic kidney disease, neuropathy, and retinopathy on all-cause mortality in type 1 and type 2 diabetes: a 21-year longitudinal study.Cardiovascular diabetology · 2022Article
- A simplified prediction model for end-stage kidney disease in patients with diabetes.Scientific reports · 2022Article
- Modifying chronic kidney disease progression with the mineralocorticoid receptor antagonist finerenone in patients with type 2 diabetes.Diabetes, obesity & metabolism · 2022Review
- GMP Compliant Synthesis of [Journal of medicinal chemistry · 2021Article
- Pentoxifylline in diabetic kidney disease (VA PTXRx): protocol for a pragmatic randomised controlled trial.BMJ open · 2021Article
- High Prevalence and Low Awareness of Albuminuria in the Community Setting in the KDSAP.Kidney international reports · 2020Article
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Authors and funding
7 authors at 5 institutions in 1 country.
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Abstract
introductionChronic kidney disease may complicate diabetes, often manifesting with reduced glomerular filtration rate (GFR), albuminuria, or both. Although greater albuminuria and lower estimated GFR both predict adverse prognosis, whether a synergistic prognostic interaction occurs in patients with diabetes has not been defined in a large national cohort study.
methodsWe used 2000-2011 data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) for 42,761 participants with diabetes. Kaplan-Meier survival analysis and multivariable Cox regression were used to ascertain the association of estimated GFR, albumin-creatinine ratio (ACR), and their interaction on all-cause mortality and progression to end-stage renal disease (ESRD) at a median 4 years of follow-up.
resultsOf 42,761 participants with diabetes, 8,618 (20.2%) had estimated GFR <60 mL/min/1.73 m(2), 7,715 (18.0%) had ACR >30 mg/g, and 2,641 (6.2%) had both. The unadjusted incidence (per 1,000 person-years) of all-cause mortality increased from 3.1 (95% CI, 2.4-3.8) in participants with estimated GFR ≥ 105 mL/min/1.73 m(2) and no albuminuria to 73.7 (95% CI, 54.9-92.5) in participants with estimated GFR <30 mL/min/1.73 m(2) and macroalbuminuria (P < 0.001). Progression to ESRD likewise increased from 0.2 (95% CI, 0-0.4) to 220.4 (95% CI, 177.2-263.6) per 1,000 person-years (P < 0.001). After adjustment for confounders, both estimated GFR and albuminuria were associated independently with mortality and progression to ESRD, with a strong synergistic interaction (P for interaction < 0.001); estimated GFR <30 mL/min/1.73 m(2) and macroalbuminuria together were associated with a 5-fold higher risk of mortality and a more than 1,000-fold higher risk of progression to ESRD (compared with patients with estimated GFR >60 mL/min/1.73 m(2) and ACR <30 mg/g; P < 0.001 for both outcomes).
conclusionsIn this large cohort of diabetic KEEP participants with more than 170,000 person-years of follow-up, both estimated GFR and albuminuria were associated independently with mortality and progression to ESRD, with a strong synergistic interaction.
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