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

Abstract

Significance Statement Understanding of the interplay between AKI and CKD in people with type 2 diabetes, and how it compares with the interplay between AKI and CKD in the nondiabetic population, is limited. In this retrospective, cohort study of 16,700 participants with or without type 2 diabetes, the authors developed an algorithm to identify AKI episodes from serum creatinine test data. In their analysis, they found that rates of AKI are significantly higher among patients with diabetes compared with those without diabetes, and this remains true for individuals without preexisting CKD. These findings demonstrate that the risk of AKI and associated adverse outcomes in this population of patients is currently underestimated. Increasing awareness may allow for implementation of simple interventions to help prevent the occurrence of AKI and thereby improve patient outcomes. Background 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. Methods 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. Results 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. Conclusions Patients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.

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