The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study

Abstract

BackgroundThere are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population.MethodsIn this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline.ResultsWe followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD.ConclusionsPatients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.

Acute Kidney Injury and Progressive Diabetic Kidney Disease: An Epidemiological Perspective

“…14 A recent observational study by Hapca et al concluded from their cohort of patients that in the absence and presence of CKD, the rates of AKI were nearly 5 times and 2 times, respectively, for patients with diabetes compared to the control groups. 16 Mechanisms postulated to explain the susceptibility of DM to AKI include endothelial dysfunction due to upregulation of vasoconstrictor endothelin −1 (ET-1), downregulation of nitric oxide production, 25,26 proximal tubular injury secondary to upregulation of inflammatory cytokines like tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, maladaptive repair process which causes scarring and tubulointerstitial fibrosis leading to CKD progression and ESKD. 27,28 We studied the incidence of AKI in our cohort as most of the observational studies included incidences of AKI only in hospitalized patients, critically ill, 11 elderly, 29 postsurgical patients 30 .…”

“…In addition, patients with a sepsis-associated AKI showed greater decline in eGFR which was in stark contrast compared to other etiologies. The prior studies 16 , 31 , 32 done on patients with diabetes mellitus and diabetic kidney disease did not study the causes for AKI. We acknowledge that sometimes there could be an overlap in the causes leading to AKI which can make it difficult to pinpoint an exact etiology.…”

“…There are very few studies that have looked into the relationship between AKI and diabetes or AKI in diabetic kidney disease. [14][15][16] Though AKI is described as a risk factor for DKD progression, intricate variables such as incidence, etiology, risk factors, impact on the rate of decline in GFR have not been well studied.…”

“…(16) Prabhu et al Dovepress submit your manuscript | www.dovepress.comDovePressInternational Journal of Nephrology and Renovascular Disease 2021:14…”

Tackling AKI: prevention, timing of dialysis and follow-up

“…Type 2 diabetes mellitus (T2DM) is a major cause of chronic kidney disease (CKD) and kidney failure. Small trials have suggested that T2DM might also be a risk factor for AKI and a large retrospective cohort study conducted by the BEAt-DKD consortium in Scotland further supports its potential as an independent risk factor in the absence of CKD 3 . In this study, 16,700 participants (9,417 with T2DM and 7,283 controls without T2DM) were followed for a median of 8.2 years.…”