{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:09:16Z","timestamp":1780567756344,"version":"3.54.1"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":154,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Diabetic kidney disease (DKD) substantially contributes to premature mortality in individuals with Type 2 diabetes (T2D). Although the 2024 American Diabetes Association (ADA) guideline incorporates the risk stratification of DKD progression into routine diabetes care, its predictive validity for mortality remains underexplored in real\u2010world populations. Using data from 6936 adults with T2D enrolled in the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, this study examined whether baseline DKD progression risk categories\u2014based on estimated glomerular filtration rate (eGFR) and urine albumin\u2010to\u2010creatinine ratio (UACR)\u2014can predict all\u2010cause and cardiovascular mortality. Risk of DKD progression was classified as low, moderately increased, high, or very high. Mortality outcomes were identified via linkage to the National Death Index until December 31, 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographics, comorbidities, lifestyle behaviors, laboratory values, and medication use. Over a median follow\u2010up of 98 months, 1781 all\u2010cause and 623 cardiovascular deaths occurred. Compared with the low\u2010risk group, the very high\u2010risk group had significantly higher risks of all\u2010cause mortality (adjusted HR: 2.53; 95% CI: 2.15\u20132.98) and cardiovascular mortality (adjusted HR: 2.47; 95% CI: 1.87\u20133.27), with a clear dose\u2010response gradient across risk categories (\n                    <jats:italic>p<\/jats:italic>\n                    for trend &lt;\u20090.001). Notably, this graded relationship remained stable across most examined subgroups, and significant interactions were observed specifically among individuals aged &lt;\u200965 years and those using renin\u2013angiotensin system (RAS) inhibitors. These findings confirm the robust prognostic utility of the ADA\u2010endorsed risk stratification matrix of DKD progression for mortality in T2D and highlight its potential to inform risk\u2010based individualized management strategies in clinical practice. This study also provides pragmatic evidence supporting the implementation of guideline recommendations.\n                  <\/jats:p>","DOI":"10.1155\/jdr\/9563077","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T09:50:51Z","timestamp":1780566651000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Stratification for Diabetic Kidney Disease Progression in Predicting All\u2010Cause and Cardiovascular Mortality in Type 2 Diabetes: A National Cohort Study From NHANES 1999\u20132018"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3761-6266","authenticated-orcid":false,"given":"Ying","family":"Qiu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6253-2083","authenticated-orcid":false,"given":"Jun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8860-6809","authenticated-orcid":false,"given":"Hongqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-1697","authenticated-orcid":false,"given":"Jianping","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1516-1133","authenticated-orcid":false,"given":"Lei","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.08.001"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30313-9"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2003.50007"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2005.00365.x"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61350-6"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60674-5"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.531"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.536"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.550"},{"key":"e_1_2_13_11_2","first-page":"1","article-title":"KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease","volume":"3","author":"Group KDIGOKCW","year":"2013","journal-title":"Kidney International"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.7326\/M23-2814"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2024.05.008"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2024.100845"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2452219"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1532494"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.17002"},{"key":"e_1_2_13_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.08.012"},{"key":"e_1_2_13_19_2","doi-asserted-by":"crossref","first-page":"S219","DOI":"10.2337\/dc24-S011","article-title":"11.Chronic Kidney Disease and Risk Management","volume":"47","author":"Care, Diabetes","year":"2024","journal-title":"Diabetes Care"},{"key":"e_1_2_13_20_2","doi-asserted-by":"publisher","DOI":"10.5551\/jat.63891"},{"key":"e_1_2_13_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-01792-y"},{"key":"e_1_2_13_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026685"},{"key":"e_1_2_13_23_2","unstructured":"Center for Disease Control and Prevention https:\/\/www.cdc.gov\/nchs\/nhanes\/index.htm.[Last accessed: 10\/1\/2024]."},{"key":"e_1_2_13_24_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-2371"},{"key":"e_1_2_13_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"e_1_2_13_26_2","unstructured":"The National Health and Nutrition Examination Survey (NHANES) https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/1999-2000\/BPX.htm#Analytic_Notes.[Last accessed: 09\/20\/2024]."},{"key":"e_1_2_13_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n604"},{"key":"e_1_2_13_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11356-023-27324-3"},{"key":"e_1_2_13_29_2","unstructured":"Public-Use Linked Mortality Files https:\/\/www.cdc.gov\/nchs\/data-linkage\/mortality-public.htm. 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