{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:55:32Z","timestamp":1761897332285,"version":"3.40.5"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T00:00:00Z","timestamp":1595808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01DK108784"],"award-info":[{"award-number":["R01DK108784"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Creatinine\u2010based estimated glomerular filtration rate (eGFR) is biased in the setting of obesity and other conditions. Alternative kidney filtration markers may be useful in adults with diabetes, but few studies examined the associations with risk of clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, we evaluated whether baseline levels and change in eGFR based on creatinine (Cr), cystatin c (Cys), <jats:styled-content>\u03b2<\/jats:styled-content><jats:sub>2<\/jats:sub>\u2010microglobulin (B2M), eGFR<jats:sub>Cr\u2010Cys<\/jats:sub>, and the average of three estimates (eGFR<jats:sub>Cr\u2010Cys\u2010B2M<\/jats:sub>) assessed in 7217 participants at baseline and a random sample of 640 participants at the 1\u2010year visit are associated with clinical outcomes. We examined associations with major macrovascular and microvascular events together and separately and all\u2010cause mortality using Cox regression models, adjusting for established risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a median follow\u2010up of 5\u2009years, 1313 major macrovascular (n = 748) and microvascular events (n = 637), and 743 deaths occurred. Lower levels of eGFR based on all filtration markers individually and combined were associated with 1.4 to 3.0 times higher risk of major macrovascular and microvascular events (combined and separately) and all\u2010cause mortality. Per 30% decline in eGFR<jats:sub>Cys<\/jats:sub>, eGFR <jats:sub>Cr\u2010Cys<\/jats:sub>, and eGFR<jats:sub>Cr\u2010Cys\u2010B2M<\/jats:sub> were associated with a &gt;2\u2010fold higher risk of all clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In adults with type 2 diabetes, baseline levels of eGFR based on alternative filtration markers and per 30% decline in eGFR<jats:sub>Cys<\/jats:sub>, eGFR <jats:sub>Cr\u2010Cys<\/jats:sub>, and eGFR<jats:sub>Cr\u2010Cys\u2010B2M<\/jats:sub> were associated with clinical outcomes. Measurement of alternative filtration markers, particularly B2M in adults with type 2 diabetes may be warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.13083","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T13:35:15Z","timestamp":1593610515000},"page":"929-941","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Alternative kidney filtration markers and the risk of major macrovascular and microvascular events, and <scp>all\u2010cause<\/scp> mortality in individuals with type 2 diabetes in the <scp>ADVANCE<\/scp> trial"],"prefix":"10.1111","volume":"12","author":[{"given":"Hyunju","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University  Baltimore Maryland 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