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Dynamic Changes in Renal Function Are Associated With Major Cardiovascular Events in Patients With Type 2 Diabetes.
- Source :
-
Diabetes care [Diabetes Care] 2016 Jul; Vol. 39 (7), pp. 1259-66. Date of Electronic Publication: 2016 May 23. - Publication Year :
- 2016
-
Abstract
- Objective: The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event.<br />Research Design and Methods: We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression.<br />Results: In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort.<br />Conclusions: Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.<br /> (© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)
- Subjects :
- Aged
Aged, 80 and over
Albuminuria complications
Biomarkers blood
Cardiovascular Diseases blood
Creatinine blood
Diabetes Mellitus, Type 2 blood
Female
France
Glomerular Filtration Rate physiology
Glycated Hemoglobin analysis
Humans
Hypertension complications
Kidney Function Tests methods
Linear Models
Male
Middle Aged
Predictive Value of Tests
Proteinuria complications
Renal Insufficiency, Chronic blood
Risk Factors
Cardiovascular Diseases complications
Diabetes Mellitus, Type 2 complications
Renal Insufficiency, Chronic complications
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 39
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 27222502
- Full Text :
- https://doi.org/10.2337/dc15-2607