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GFR decline predicts total mortality and mediates the effect of tryptophan metabolism on death risk in type 2 diabetes.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Aug 13. Date of Electronic Publication: 2024 Aug 13. - Publication Year :
- 2024
- Publisher :
- Ahead of Print
-
Abstract
- Context: The independent role of glomerular filtration rate (GFR) decline in shaping the risk of mortality in people with type 2 diabetes has only been partially addressed.<br />Objective: The objective of the study was twofold: i) to investigate the association between all-cause mortality and eGFR changes over time; ii) to understand whether renal dysfunction mediates the effect of tryptophan metabolism on death risk.<br />Design: Prospective study with an average follow-up of 14.8 years.<br />Setting: Research Hospital.<br />Patients: The aggregate Gargano Mortality Study included 962 patients with type 2 diabetes who had at least three eGFR recordings and at least 1.5 years of follow-up.<br />Interventions: This was an observational study, with no intervention.<br />Main Outcome Measures: Rate of all-cause mortality.<br />Results: Age and sex adjusted annual incident rate of mortality was 2.75 events per 100 person-years. The median annual rate of decline of eGFR was 1.3 ml/min per 1.73 m2 per year (range -3.7; 7.8). The decline of kidney function was strongly and independently associated with the risk of death. Serum kynurenine-to-tryptophan ratio (KTR) was associated with both eGFR decline and all-cause mortality. Causal mediation analysis showed that 24.3% of the association between KTR and mortality was mediated by eGFR decline.<br />Conclusions: In patients with type 2 diabetes, eGFR decline is independently associated with the risk of all-cause mortality and mediates a significant proportion of the association between tryptophan metabolism and death.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our siteāfor further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)
Details
- Language :
- English
- ISSN :
- 1945-7197
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 39136240
- Full Text :
- https://doi.org/10.1210/clinem/dgae551