Relative leucocyte telomere length is associated with incident end-stage kidney disease and rapid decline of kidney function in type 2 diabetes: analysis from the Hong Kong Diabetes Register

Aims/hypothesis Few large-scale prospective studies have investigated associations between relative leucocyte telomere length (rLTL) and kidney dysfunction in individuals with type 2 diabetes. We examined relationships between rLTL and incident endstage kidney disease (ESKD) and the slope of eGFR decline in Chinese individuals with type 2 diabetes. Methods We studied 4085 Chinese individuals with type 2 diabetes observed between 1995 and 2007 in the Hong Kong Diabetes Register with stored baseline DNA and available follow-up data. rLTL was measured using quantitative PCR. ESKD was diagnosed based on the ICD-9 code and eGFR. Results In this cohort (mean +/- SD age 54.3 +/- 12.6 years) followed up for 14.1 +/- 5.3 years, 564 individuals developed incident ESKD and had shorter rLTL at baseline (4.2 +/- 1.2 vs 4.7 +/- 1.2,p < 0.001) than the non-progressors (n = 3521). On Cox regression analysis, each Delta Delta C-1 decrease in rLTL was associated with an increased risk of incident ESKD (HR 1.21 [95% CI 1.13, 1.30], p < 0.001); the association remained significant after adjusting for baseline age, sex, HbA(1c) , lipids, renal function and other risk factors (HR 1.11 [95% CI 1.03, 1.19], p = 0.007). Shorter rLTL at baseline was associated with rapid decline in eGFR (>4% per year) during follow-up (unadjusted OR 1.22 [95% CI 1.15, 1.30],p < 0.001; adjusted OR 1.09 [95% CI 1.01, 1.17],p = 0.024). Conclusions/interpretation rLTL is independently associated with incident ESKD and rapid eGFR loss in individuals with type 2 diabetes. Telomere length may be a useful biomarker for the progression of kidney function and ESKD in type 2 diabetes.

Automated summary

This study found that rLTL is independently associated with incident ESKD and rapid eGFR decline in Chinese individuals with type 2 diabetes. Shorter rLTL at baseline was linked to a higher risk of developing ESKD and a faster decline in kidney function during follow-up. Telomere length may serve as a useful biomarker for predicting kidney disease progression in type 2 diabetes patients.