Work

A Real-World Cohort Study of the Risks of Kidney Failure and Death in Diabetes

Year: 2025

Type: article

Abstract: Background: Risks of kidney failure and death are high in people with diabetes. The study aim was to estimate contemporary rates and predictors of these outcomes in a real-world population.Methods: Prevalence and cumulative incidence functions for kidney failure and all-cause death, stratified by baseline estimated glomerular filtration rate (eGFR), were estimated for the diabetes population in the Center for Kidney Disease Research, Education, and Hope Registry (2013–2022). Cox proportional hazards models assessed demographic, clinical, and health-care variables for predicting kidney failure and death.Findings: Among 618 739 persons with diabetes followed for a median (interquartile range) of 3.79 (1.80–6.00) years, 4% (n=24 097) developed kidney failure and 10% (n=63 128) died. Five-year cumulative incidence of kidney failure increased from 1.5% (95% confidence interval [CI] 1.4%–1.5%) for eGFR ≥90 mL/min/1⸱73m2 to as high as 62.3% (95% CI 61.0%–63.5%) for eGFR 15–29 mL/min/1⸱73m2. Cumulative incidence of all-cause death was higher than for kidney failure with baseline eGFR ≥45 mL/min/1⸱73m2, whereas kidney failure became more common at eGFR <30 mL/min/1⸱73m2. Hazards of kidney failure were increased in: men; 40–59 and 60–79 year age groups; American Indian or Alaska Native, Asian, non-Hispanic Black or African American, Native Hawaiian or Pacific Islander, or Hispanic or Latino/a groups; and those with noncommercial health insurance or prior hospitalization compared to their respective reference groups. Hazards of death were similar except that age ≥80 years imparted the greatest risk, and only the American Indian or Alaska Native group had increased risks.Interpretation: In a large, real-world diabetes population, all-cause death was more frequent than kidney failure at eGFR ≥45 mL/min/1⸱73m2, but this trend reversed at lower eGFR levels. Disparities in risks of kidney failure and death point to opportunities for risk-based monitoring and interventions to improve outcomes.Funding: This work was supported by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264.Declaration of Interest: KRT is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568, and OT2OD032581, as well as CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264. She has also received investigator- initiated grant support from Travere Therapeutics Inc., Bayer, Doris Duke Charitable Foundation, and Benaroya Research Institute. She reports consultancy fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Travere Therapeutics Inc, and Pfizer, as well as speaker fees from Novo Nordisk. Additionally, she reports being chair of data safety monitoring boards for the National Institute of Diabetes and Digestive and Kidney Disease, and George Clinical Institute, and member of the data safety monitoring board for AstraZeneca. She reports leadership roles as chair for the Diabetic Kidney Disease Collaborative for the American Society of Nephrology, chair for Kidney Week 2025 Program Committee, and a member of the American Heart Association/American College of Cardiology Cardiovascular-Kidney-Metabolic Guideline Committee. LMK is supported by a NIH research grant OT2OD032581 and CDC project numbers 75D301-21-P- 12254 and 75D301-23-C-18264 and reports other support from Travere Therapeutics Inc and Benaroya Research Institute. CRJ is supported by NIH research grants R01MD014712 and OT2OD032581 and CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264 and reports other support from Travere Therapeutics Inc., Doris Duke Charitable Foundation and Benaroya Research Institute. CLR is supported by NIH research grant OT2OD032581 and CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264 and reports other support from Travere Therapeutics Inc., Doris Duke Charitable Foundation and Benaroya Research Institute. RZA is supported by NIH research grants OT2HL161847, OT2OD032581, and U24TR001608 and CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264 and reports other support from Travere Therapeutics Inc., Doris Duke Charitable Foundation, Benaroya Research Institute, Bayer AG, AstraZeneca, Novo Nordisk, The George Institute for Global Health, CareDx, and KBP BioSciences, as well as personal fees from Boehringer Ingelheim, Bayer Pharmaceuticals, and Eli Lilly. She also reports being a member of the Executive Council for the American College of Physicians, Washington Chapter. KBD is supported by NIH research grants R01MD014712 and OT2OD032581 and CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264 and reports other support from Travere Therapeutics Inc., Doris Duke Charitable Foundation, and Benaroya Research Institute. JJN is supported by NIH research grant OT2OD032581 and a research grant from the American College of Clinical Pharmacy, reports consulting fees and from Bayer AG, Sanofi, Boehringer Ingelheim, Eli Lilly, and Proteomics International, and serves on the Board of Directors for the American Diabetes Association. OKD is supported by NIH research grants R25HL161609, R18DK122372, R01DK124503, R01DK127733, R01AI135029, and P30AG021684 and CDC cooperative agreement U18DP006535, and receives research support from the Patient-Centered Outcomes Research Institute and the Terasaki Institute of Biomedical Innovation. SBN is supported by NIH research grants R01MD014712, RF00250-2022-0038, U2CDK129496, and P50MD017366 and CDC project number 75D301-21-P-12254 and received research support from Travere Therapeutics Inc., Terasaki Institute of Biomedical Innovation, and personal fees and other support from AstraZeneca, Bayer AG, Gilead, Novo Nordisk, Boehringer Ingelheim, Eli Lilly, and Vertex. She reports speaker fees from Boehringer Ingelheim, a pending US Patent Provisional Application for a Novel Small Molecule Drug to Treat Diabetic Kidney Disease. Additionally, she participates in in an NIH/NIDDK and PCORI advisory board for Health System Outreach to Eliminate Disparities in Living Kidney Transplants (STEPS), is President of Women in Nephrology, and a board member of the National Kidney Foundation of Southern California. KCN is supported in part by NIH research grants UL1TR001881, P30AG021684, U2CDK129496, and P50MD017366 and reports personal fees from Atlantis Dialysis Inc and AstraZeneca. MEP has no disclosures to report.Ethical Approval: The authors planned, conducted, and reported this study according to STROBE guidelines. The Providence and UCLA Health institutional review boards approved the study and determined that written informed consent was not required for this study of a limited dataset.

Source: Clinical Journal of the American Society of Nephrology

DOI: 10.2215/cjn.0000000857