Progression of albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years in people with type 2 diabetes. Drivers, potential protectors and associated mortality
Authors' conclusion
This study revealed several factors that are associated with accelerated progression of CKD over 20 + years, including female sex and current/previous smoking. At baseline, the group with ACR >3 mg/mmol exhibited the highest rate of ACR increase. Multiple factors influenced eGFR decrease in those with baseline eGFR ≥60 mL/min/1.73 m2. Mortality rate was profoundly influenced by historical CKD status.
Study context
- Population
- Individuals with T2D followed over 24 years (2001–2024); 59.6% male, mean age 56.6 ± 12.4 years
- Participants
- 718 individuals
- Exposure
- Baseline chronic kidney disease (CKD) status: no CKD vs increased ACR/preserved eGFR vs increased ACR/reduced eGFR
- No CKDn = 451reference
- Outcome
- Rate of change of ACR and eGFR and its predictors (sex, smoking, HbA1c, SBP, DBP, body mass index (BMI))
- Follow-up
- 24 years
Methodological detailslongitudinal modelling, Mean follow-up 16.4 ± 2.1 years
- Longitudinal modelling
- Mean follow-up 16.4 ± 2.1 years
Main finding
As reported in the abstract
- eGFR decrease per year
- 1.02 mL/min/1.73 m²
- Predictor of ACR progression: Systolic blood pressure (SBP) β
- 0.36 (0.24, 0.48) (95% CI)
- Predictor of ACR progression: Diastolic blood pressure (DBP) β
- 0.40 (0.16, 0.64) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): female sex β
- −3.79 (1.96, 5.63) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): SBP β
- −0.12 (−0.17, −0.06) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): DBP β
- −0.19 (−0.08, −0.31) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): HbA1c β
- −1.17 (−0.63, −1.71) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): baseline cholesterol β
- 0.86 (0.29, 1.43) (95% CI)
- Predictor of eGFR progression (non-CKD at baseline only): smoking β
- −2.05 (−3.80, −1.30) (95% CI)
Observational data: associations, not effects.
Further findings
Mortality by baseline CKD status · end of follow-up
10 year mortality rate
- Progression to CKD (ACR >3 mg/mmol and/or eGFR<60) among those with no CKD at baseline · 24-year follow-up
- 43% · 196 of 451
- Mortality by baseline CKD status — Died in whole cohort
- 436 (60%)
Progression to end-stage kidney disease (eGFR<15 mL/min/1.73 m²), whole cohort
- Patients progressing to end-stage kidney disease
- 10 (1.4%)
Original publication
Progression of albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years in people with type 2 diabetes. Drivers, potential protectors and associated mortality. Diabet Med. Published 31 December 2025. doi:10.
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