The association between estimated glomerular filtration rate, albuminuria, and risk of cardiovascular hospitalizations and all-cause mortality among patients with type 2 diabetes

• Published in: Journal of diabetes and its complications Vol. 32; no. 3; pp. 291 - 297
• Main Authors: Nichols, Gregory A., Déruaz-Luyet, Anouk, Hauske, Sibylle J., Brodovicz, Kimberly G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018; Elsevier Limited
• Subjects: Aged; Albuminuria; Albuminuria - complications; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Creatinine - metabolism; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - mortality; Diabetic Angiopathies - epidemiology; Diabetic kidney disease; eGFR; Female; Generalized linear models; Glomerular Filtration Rate; Health risk assessment; Heart failure; Hospitalization; Humans; Incidence; Kidney diseases; Laboratories; Longitudinal Studies; Male; Middle Aged; Mortality; Survival Rate; eGFR; Cardiovascular disease; Albuminuria; Mortality; Diabetic kidney disease
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2017.12.003

We evaluated the simultaneous effects of all clinically recognized categories of albuminuria and estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) and mortality We conducted a longitudinal observational study of 16,678 type 2 diabetes (T2D) patients. From the first serum creatinine value from 2006 to 2012 and a urine-albumin creatinine ratio (UACR) recorded within 6months, we applied baseline Kidney Disease: Improving Global Outcomes (KDIGO) categories of eGFR and albuminuria. We followed patients for up to 11years to calculate adjusted incidence per 1000person-years (p-y) of first CVD hospitalization and all-cause mortality. Over 98,069p-y of follow-up, CVD hospitalization risk was greater for each higher eGFR and albuminuria category. In eGFR category G2 (60-89mL/min/1.73m2), adjusted incidence per 1000p-y was 14.1 (95% CI 12.9-15.5), 19.8 (17.2-22.8), and 22.8 (17.4-30.0) for normoalbuminuria, microalbuminuria and macroalbuminuria, respectively. For eGFR category G3a (45-59), rates were 26.7 (22.3-32.0), 40.3 (32.2-50.5), and 44.1 (28.8-67.4), respectively. Adjusted risk of all-cause mortality followed a similar pattern. Our data underscore the importance of including detailed eGFR and UACR values in assessing CVD risk. High albuminuria and low eGFR is a potent predictor of CVD and death.