Min Jun, PhD, MScMed, MSc, BSc, on Common Renal Measures May Improve Risk Stratification in T2D

New research presented at the American Society of Nephrology’s Kidney Week 2018 suggests that 2 key indicators of renal function may help assess the likelihood of experiencing a major event over time in type 2 diabetes.

In a study of 8766 patients with type 2 diabetes, lead author Min Jun, PhD, MScMed, MSc, BSc, of the George Institute and University of New South Wales Sydney, and colleagues found that those with decreased estimated glomerular filtration rate (eGFR) and/or increased urine albumin-to-creatinine ratio (UACR) had an elevated risk of major clinical outcomes over 2 years.

Consultant360 spoke with Dr Jun about the findings and their clinical implications in treating patients with type 2 diabetes and renal dysfunction.

Consultant360: How did your study come about? Why did you decide to assess the impact of changes in eGFR and UACR ratio on clinical outcomes among patient with type 2 diabetes?

Min Jun: Recent data have shown the clinical utility of albuminuria or eGFR change as a prognostic tool in determining future risk of long-term clinically important renal and cardiovascular outcomes among people with type 2 diabetes mellitus. However, such assessments have largely focused on assessing these prognostic markers individually and not in combination. We therefore sought to study whether combining changes in eGFR and UACR more accurately predicts outcomes in type 2 diabetes mellitus compared with assessing either change alone. 

C360: Your study found that clinically significant decreases in eGFR and increases in UACR over 2 years both independently and in combination predicted a higher risk of major outcomes in patients with type 2 diabetes. Knowing the relationship between diabetes and kidney disease, is this an outcome that you expected?

MJ: Albuminuria predicts longer-term clinical outcomes, independently of eGFR (and vice-versa). Current guidelines set forth by Kidney Disease Improving Global Outcomes (KDIGO) show that individuals at highest risk of poor long-term prognosis are those with relatively lower levels of eGFR and greater levels of albuminuria. Similarly, it would be reasonable to expect that clinically meaningful changes in these prognostic markers could be predictive of subsequent risk of developing adverse outcomes. Our results were largely consistent with these expectations.

C360: What are the clinical takeaways from your study? How can clinicians apply these findings in practice?

MJ: Our results suggest that that a combined assessment of clinically meaningful changes in both eGFR and UACR compared with separate assessments of the 2 markers may further improve risk stratification in type 2 diabetes mellitus.

C360: What would you say are the next steps in your research?

MJ: Our study suggests that further confirmatory assessments are warranted among high-risk populations such as diabetes.

—Christina Vogt

Reference:

Jun M, Ohkuma T, Perkovic V, Chalmers JP, Woodward M; ADVANCE Collaborative Group. Combination of changes in eGFR and albuminuria and the risk of major clinical outcomes in type 2 diabetes mellitus (T2DM). Paper presented at: American Society of Nephrology Kidney Week 2018; October 23-28, 2018; San Diego, CA.