Variability in eGFR and the risk of major clinical outcomes in diabetes: post-hoc analysis from the ADVANCE trial

There are limited data on whether estimated glomerular filtration rate (eGFR) variability modifies the risk of future clinical outcomes in type 2 diabetes mellitus (T2DM). We assessed the association between 20-month eGFR variability and the risk of major clinical outcomes in T2DM amongst 8241 participants in the ADVANCE trial. Variability in eGFR (coefficient of variation;CVeGFR ) was calculated from 3 serum creatinine measurements over 20 months. Participants were classified into 3 groups by thirds of CVeGFR : low (≤6.4;reference), moderate (>6.4 to ≤12.1) and high (>12.1). The primary outcome was the composite of major macrovascular events, new or worsening nephropathy and all-cause mortality. Cox regression models were used to estimate hazard ratios (HRs). Over a median follow-up of 2.9 years following the 20-month period, 932(11.3%) primary outcomes were recorded. Compared with low variability, greater 20-month eGFR variability was independently associated with higher risk of the primary outcome (HR for moderate and high variability:1.07, 95%CI:0.91-1.27 and 1.22, 95%CI:1.03-1.45, respectively) with evidence of a positive linear trend(p=0.015). These data indicate that eGFR variability predict changes in the risk of major clinical outcomes in T2DM. This article is protected by copyright. All rights reserved.