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Biomarkers of Major Adverse Outcomes in Diabetes

Nov 13, 2015

Recent study suggests that compelling biomarkers may predict major adverse outcomes, including death, in diabetes.

It is widely accepted and known that individuals diagnosed with diabetes are more inclined to develop cardiovascular and non-cardiovascular complications. Separate studies have shown that acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) predict adverse outcomes. However, when these factors are considered collectively, their respective prognostic significance is unknown. Therefore, researchers conducted a study to further explore this interest.

Patients diagnosed with T2DM recruited in the SURDIAGENE cohort study were prospectively followed up for major diabetes-related events, including death with cause, major cardiovascular events (MI, stroke, CHF, amputation, and arterial revascularization), and renal failure (sustained doubling of SCr or ESRD).

It was found that intra-hospital AKI occurred in 411 subjects of 1,371 individuals studied during the average 69-month follow-up period. Acute kidney injury was significantly associated with cardiovascular and non-cardiovascular death (including cancer-related death) in multivariate analyses. Furthermore, AKI was a significant predictor of major adverse cardiovascular events, heart failure requiring hospitalization, MI, stroke, lower limb amputation or revascularization, and carotid artery revascularization.

Authors claim that AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predict all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure.

Practice Pearls:

  • For the first time AKI has been observed to predict the risk for all-cause death and CV death in a cohort study dedicated to T2DM.
  • AKI, low eGFR, and elevated albuminuria are convincing biomarkers of major adverse outcomes and death in diabetes.
  • AKI was associated with cancer-related and infection-related death.
  • AKI may be associated with inflammation, possibly leading to systemic consequences; however, exact mechanism of the association between AKI and major adverse outcomes remains unknown.

Monseu, Mathilde, et al. “Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria.” Diabetes Care (October 28, 2015): dc151222.