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IntroductionPeople with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia.Research design and methodsWe analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site.ResultsThe mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was −1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: −2.11; 95% CI: −3.45 to –0.77), previous cardiovascular disease (−1.93; 95% CI: −3.45 to –0.40), and statins use (−0.87; 95% CI: −1.65 to –0.10) were associated with faster eGFR decline.ConclusionsPeople with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications.Trial registration numberNCT01212328.
IntroductionPeople with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia.Research design and methodsWe analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site.ResultsThe mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was −1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: −2.11; 95% CI: −3.45 to –0.77), previous cardiovascular disease (−1.93; 95% CI: −3.45 to –0.40), and statins use (−0.87; 95% CI: −1.65 to –0.10) were associated with faster eGFR decline.ConclusionsPeople with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications.Trial registration numberNCT01212328.
Background With metabolic disorders on the rise globally, the cardiometabolic index (CMI) has emerged as a crucial predictor of mortality risks linked to cancer, cardiovascular disease, and diabetes. This novel index, which combines lipid metabolism and body composition, is the focus of this study, aimed at exploring its association with all-cause and specific mortality in an all-age adult population. Methods A longitudinal cohort study including 5,728 participants aged over 18 from nine cycles between 2001 and 2018 was enrolled and assessed. CMI served as the exposure variable, while outcomes included all-cause mortality and mortality due to cardiovascular disease, cancer, and diabetes. The Cox frailty model and average marginal effects were employed to evaluate the contribution of CMI to all-cause and specific mortality collectively. Restricted cubic spline analyses and stratified analyses were conducted to investigate potential nonlinear effects and interactions. Results The decreased participants exhibited considerably higher CMI than the alive’s. A positive association was found between CMI and all-cause mortality (HR=1.05, 95% CI=1.01-1.10). Notably, CMI was linked to an increased risk of cancer mortality (HR=1.02) and a reduced risk of cardiovascular disease mortality (HR=0.85). Furthermore, the average marginal effect of CMI on diabetes mortality was the largest (AME=0.499). The RCS curves revealed that participants had the lowest risk of all-cause mortality at a CMI of 0.618. Sensitivity analyses further supported these findings. Conclusion This study represents the first comprehensive assessment on the contribution of CMI to mortality across an all-age adult population, providing some insights for the comprehensive assessment of health and disease states. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-024-02415-3.
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