Association of kidney disease measures with risk of renal function worsening in patients with hypertension and type 2 diabetes

Aims To assess the role of kidney disease measures on the development of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and hypertension (HT). Methods Clinical records from a total of 17,160 patients with T2D and HT, a baseline estimated glomerular filtration rate (eGFR) values ≥ 60 mL/min/1.73m2, evaluation for albuminuria and regular visits during a four-year follow-up were retrieved and analyzed. The incidence of eGFR < 60 mL/min/1.73m2 and/or a reduction > 30% from baseline was evaluated. Results At baseline 23% of patients (n = 3873) had albuminuria. Over the 4-year follow-up 20% (n = 3480) developed a renal endpoint 28% (n = 1074) of those with albuminuria and 17% (n = 2406) of those without albuminuria. The presence of baseline albuminuria entailed a 1.8 independent, greater risk of reaching stage 3 CKD. Patients with normal albuminuria showed a 1.54 (p < 0.001) greater risk for each 5 mL reduction (below 90 mL/min) in baseline GFR. Conclusions In T2D patients with HT, eGFR reduction and albuminuria are independently associated with a greater risk of developing stage 3 CKD. While baseline albuminuria entails a greater renal risk, due to a larger occurrence of the non-albuminuric phenotype, renal function worsening is more likely to be observed in patients without albuminuria.