Risk stratification in diabetic kidney disease (DKD) remains complex, particularly for predicting cardiovascular (CV) outcomes. A retrospective analysis of the National Health and Nutrition Examination Survey (NHANES) cohort published in Clinical Diabetology evaluated the association between the relative difference in estimated glomerular filtration rate (eGFRdiff) and CV outcomes in patients with DKD.

The study included 552 individuals with DKD from NHANES 1999-2004. eGFRdiff was categorized into three groups: >10, −10 to 10, and <−10 mL/min/1.73 m². Multivariable-adjusted regression models assessed associations with outcomes after accounting for demographics, comorbidities, and medication use. Restricted cubic spline analysis was used to evaluate potential nonlinear relationships.

Compared with the highest eGFRdiff group, the lowest group (<−10 mL/min/1.73 m²) was associated with a higher risk of all-cause mortality (adjusted HR 1.81; 95% CI 1.13-2.90) and CV mortality (adjusted HR 2.53; 95% CI 1.29-4.97). A nonlinear inverse association between eGFRdiff and CV events was observed (p for nonlinearity = 0.020). Higher eGFRdiff values were associated with increased risk of coronary artery disease (p=0.006), while no significant association was observed with stroke.

These findings indicate that eGFRdiff is associated with mortality and cardiovascular outcomes in DKD, with lower values linked to higher risk. Integration of eGFRdiff into clinical assessment may support improved risk stratification in this population.