Ethnic differences in the progression of chronic kidney disease in a UK diabetic population: An observational cohort study.

Conference:

SAPC ASM 2018 - London

Talk Code:

2E.6

Presenter:

Rohini Mathur

Co-authors:

Gavin Dreyer, Magdi M Yaqoob, Sally Hull

Author institutions:

Centre for Primary Care and Public Health, Queen Mary University of London, Department of Nephrology, Barts Health NHS trust, London

Problem

Ethnic minority groups are known to have a higher prevalence of T2DM and end stage renal failure (ESRF) compared to the white majority population. Whether this excess of ESRF is a result of faster progression of chronic kidney disease (CKD) in ethnic minority groups remains poorly understood. The aim of this study was to establish the role of ethnicity alongside other major risk factors in the progression of CKD in people with T2DM mellitus managed in community settings.

Approach

An observational cohort study using prospectively collected electronic primary care data from the East London Database was conducted. Participants included adults aged 25-85 with established T2DM and CKD at baseline from 135 primary care practices in east London. Patients entered the study at the date of CKD onset following their initial T2DM diagnosis. The annual rate of renal decline was compared between white, south Asian, and black groups, and stratified by proteinuria and raised blood pressure at baseline. Predictors of rapid renal decline (average annual eGFR loss of ≥5 ml/min/1.73m2) were identified in a nested case control study.

Findings

Age-sex adjusted annual decline was greatest in the Bangladeshi population. There was stepwise increase in the rate of decline when stratifying the cohort by baseline proteinuria and BP control, with south Asian groups being most sensitive to the combined effect of proteinuria and raised blood pressure after accounting for key confounders. The odds of rapid renal decline were increased for individuals of Bangladeshi, African, and Caribbean ethnicity, those with hypertension, proteinuria, CVD, and with increasing duration of diabetes. Rapid progression was more frequent in younger age groups.

Consequences

Proteinuria and hypertension trigger accelerated eGFR decline differentially by ethnicity. Active monitoring of younger adults, who have greater odds of rapid progression and the most to gain from interventions, is essential.

Submitted by:

Rohini Mathur

Funding acknowledgement:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.