ABO/Rh Blood Group Phenotypes as Predictor of Treatment Outcomes in Diabetic Kidney Disease

Background and aim: ABO blood groups are biologically plausible modulators of endothelial function, coagulation, and inflammation - pathways central to diabetic kidney disease (DKD). This study evaluates whether ABO/Rh phenotypes associate with differential treatment outcomes in DKD. Methods: This 1-year prospective cohort study enrolled 161 adults with type 2 diabetes and established DKD (all receiving ACE-I/ARB plus SGLT2 inhibitors) from Cairo University outpatient clinics. eGFR, ACR, HbA1c, lipids, electrolytes, and blood pressure were assessed at baseline and one year. Percent changes in eGFR and ACR were calculated and the Kidney Failure Risk Equation estimated 2- and 5-year risk of progressing to end stage kidney disease. Multivariable linear regression identified independent predictors of renal outcome changes.

Inclusion Criteria: * Adults aged ≥18 years with type 2 DM * Evident diabetic kidney disease * Recorded ABO blood group phenotypes * Receiving Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARBs) in addition Sodium-glucose cotransporter 2 inhibitor (SGLT2i) as part of their ongoing therapy prior to enrolment. Exclusion Criteria: * Pre-existed glomerular diseases or any other primary kidney disorder, * Active urinary sediment * Type 1 diabetes mellitus * Gestational diabetes * History of kidney transplantation * Documented episode of acute kidney injury, * Family history of non-diabetic forms of kidney disease * \>30% declines in eGFR after initiation of RAAS inhibitors