Introduction:

The pathophysiology of chronic kidney disease (CKD) in type 2 diabetes (T2D) is multifactorial. This study assessed changes in albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years and evaluated factors influencing these changes in T2D patients.

Methods:

• Population: 718 individuals diagnosed with T2D (2001–2024)
• Analysis: Longitudinal modelling to assess yearly rate changes in ACR/eGFR and predictors across:
  • Total sample
  • Subsamples:
    • No-CKD
    • CKD with increased ACR/preserved eGFR
    • CKD with increased ACR/low eGFR

Results:

1. Overall yearly change:
   1. ACR: Increased exponentially by 0.91 mg/mmol per year
   2. eGFR: Declined linearly by 1.02 mL/min/1.73m² per year
2. ACR progression predictors (particularly in CKD with increased ACR/preserved eGFR group):
   1. Systolic BP (β=0.36, 95% CI [0.24, 0.48])
   2. Diastolic BP
3. eGFR decline predictors (significant only in non-CKD baseline subgroup):
   1. Female sex
   2. Systolic BP (β=−0.12, 95% CI [−0.17, −0.06])
   3. Diastolic BP
   4. HbA1c (β=−1.17, 95% CI [−0.63, −1.71])
   5. Baseline cholesterol (β=0.86, 95% CI [0.29, 1.43])
   6. Smoking (β=−2.05, 95% CI [−3.80, −1.30])

Conclusion:

Many factors are associated with progression of CKD over 20+ years including female sex, smoking and higher blood pressure. Thus for prevention and reducing the degree of renal complications it is necessary to conduct timely risk profiling and intervention.

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