Ethnic differences in CKD progression among people with type 2 diabetes and rapid eGFR decline: A secondary data analysis.

BACKGROUND

People with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) exhibit diverse patterns of kidney function decline. However, there is limited evidence on the impact of ethnicity and diabetic retinopathy on the rate of estimated glomerular filtration rate (eGFR) decline and the progression of CKD.

METHODS

We analysed 14,489 people with T2DM and baseline eGFR ≥ 45 ml/min/1.73 m² attending outpatient clinics at south London hospitals from 2004 to 2018. The ethnically diverse cohort included 45% White, 37.8% Black, 9.1% Asian, 2.7% Mixed, and 5.2% Other ethnicities. The latent class analysis approach, Group Based Trajectory Model (GBTM) was used to identify eGFR trajectories, and multinomial logistic models assessed CKD progression to stages 4 and 5 among those with faster eGFR decline (≥ 1.92 ml/min/year).

RESULTS

Four eGFR trajectories were identified from each ethnic group. Those with the fastest decline (n = 2,531) were older, had higher urine albumin-to-creatinine ratio (ACR), and lower baseline eGFR. Of this group, 368 (14.53%) progressed to stage 5 CKD. Relative risk ratios (95% CI) of progression compared to White individuals were 1.64 (1.22-2.21) for Black, 2.39 (1.57-3.64) for Asian, 1.97 (1.11-3.50) for Mixed, and 3.72 (2.11-6.57) for other ethnicities. Diabetic retinopathy at baseline was present in 17.58% of this group, and linked to faster CKD progression, particularly among Black individuals.

CONCLUSION

Non-White ethnicities experience faster CKD progression, with diabetic retinopathy contributing significantly, especially in Black individuals. These findings highlight the need for tailored strategies of prevention and intervention to address disparities in CKD outcomes.