Variability in estimated glomerular filtration rate and the risk of major clinical outcomes in diabetes: Post hoc analysis from the ADVANCE trial

Abstract

There are limited data on whether estimated glomerular filtration rate (eGFR) variability modifies the risk of future clinical outcomes in type 2 diabetes (T2D). We assessed the association between 20‐month eGFR variability and the risk of major clinical outcomes in T2D among 8241 participants in the ADVANCE trial. Variability in eGFR (coefficient of variation [CVeGFR]) was calculated from three serum creatinine measurements over 20\u2009months. Participants were classified into three 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\u2009years 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 = .015). These data indicate that eGFR variability predict changes in the risk of major clinical outcomes in T2D.