420-P: Effects of Nonalbuminuric Type 2 Diabetes Mellitus on Renal Outcomes

Introduction & Objective: The classic pattern of diabetic kidney disease is typically followed by microalbuminuria. However, the pure impact of type 2 diabetes mellitus (T2D) without albuminuria on renal outcomes is not fully understood. This study aimed to investigate the renal outcomes in non-albuminuric T2D compared to non-albuminuric non-T2D subjects. Methods: Data from the National Health Insurance Service-National Sample Cohort of Korea from 2009 to 2015 were analyzed. Subjects with an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 at baseline and within the normal range of albuminuria were included. They were divided into T2D and non-T2D groups. The primary outcome was a composite renal outcome, consisting of the initiation of renal replacement therapy and a decline of ≥ 40% in eGFR from baseline. Results: A total of 77,267 patients were analyzed (11,957 in the T2D group vs. 65,310 in the non-T2D group). In a linear mixed model, the T2D group showed a significantly greater annual decline in eGFR of -0.113 ml/min/1.73 m2 (95% CI: -0.222 to -0.003, p = 0.044) compared to the non-T2D group. The primary outcome, the adjusted hazard ratio for the composite renal outcome, was 1.57 (95% CI: 1.28-1.92, p < 0.001). Conclusion: Non-albuminuric T2D was associated with a greater annual decline in renal function and had a 1.5-fold increased risk of adverse renal outcomes compared to non-albuminuric non-T2D subjects.