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Correlation Between Chronic Kidney Disease Progression and Cerebral Vascular Disease Outcomes in Type 2 Diabetes

Mar 6, 2021
 
Editor: Steve Freed, R.PH., CDE

Author: Aleksandra Kusic, PharmD Candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences

Results of an extensive retrospective study indicate a strong association between glomerular filtration rate (eGFR) and cardiovascular disease (CVD) morbidity rate. 

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Studies have further shown that the progression of the two is associated with increased morbidity and mortality rates in patients with diabetes. Research has shown that it is essential to diagnose cardiovascular disease (CVD) as soon as possible. Knowing that chronic kidney disease patients have a greater risk of developing CVD, preventative and treatment options can be implemented at earlier stages of patient diagnosis to increase the chances of better outcomes. A large cohort study examined the association between CKD progression, based on measured estimated glomerular filtration (eGFR), and an increased risk of cardiovascular events to evaluate the association between CVD and CKD progression.  

 

According to study authors Cabrera and colleagues, the rate of renal deterioration remained positively correlated to the incidence of heart failure in type 2 diabetes (T2DM) subjects, independently of most current renal health variables. This study showed how eGFR could serve as a biomarker to predict the risk factors of developing CVD. It can also be used to examine any improvement or worsening of kidney function; thus, creating a treatment plan that can address CVD prevention in type 2 diabetes patients with kidney disease can reduce morbidity and mortality rates. 

This study obtained subject data from the UK Clinical Practice Research Data Link (CPRD), where patient information is stored using an electronic health record IT information system. The data of 30,222 subjects identified as newly diagnosed with CKD in type 2 diabetes was collected and analyzed. The study looked specifically at the United Kingdom diabetic population with a diagnosis code or anti-diabetic treatment code from January 1, 1995, to December 31, 2015, for CKD. The inclusion criteria required subjects to have had a CKD selection index date that occurred after T2DM diagnosis, with at least 12 months of data before that CKD index date. Patients who had a previous history of CVD, such as heart failure, myocardial infarction, ischemic stroke, or compensation of all three (MACR plus) during the year before the CKD index date or two years following the CKD index, were excluded. Exclusion occurred to assure that the incidents occurred during the follow-up period. Subjects were followed from CKD diagnosis until one of these three CVDs occurred, or until mortality, database drop out, or end-of-study follow-up. The study compared the updated eGFR slope categories for association to each CVD event (3 mL/min/1.73 m2, 0 mL/min/1.73 m2 to <3 mL/min/1.73 m2, <0 mL/min/1.73 m2 to -3 mL/min/1.73 m2, -3 mL/min/1.73 m2) and the mean eGFR over a 2-year period. The study aimed to determine if the eGFR decline could be a prediction of CVD.  

This study showed an association between MACR plus and heart failure with the updated eGFR slope and updated eGFR. The CPRD was able to capture eleven values per patient using updated eGFR slope and eGFR. There was an increased risk for MACE plus heart failure for each eGFR decline of less than -3ml/min/1.732. MACE plus (adj HR 1.45; 95% CI 1.26 to 1.67), HF (HR 1.50; 95% CI 1.27 to 1.76), and MI (HR 1.39; 95% CI 1.01 to 1.91). These results indicate a correlation between the decline in kidney function and increased risk for CVD. Monitoring kidney function can be done by testing the GFR, and prevention measures should be implemented to decrease CVD incidence.   

The study also showed that other risk factors such as age, male gender, smoking, and having type 2 diabetes over five years before CKD diagnosis, can contribute to CVD outcomes. Therefore, other risk factors should be taken into consideration when developing a prevention plan. 

This study highlights the importance of prevention and treatment for CKD patients to prevent CVD and decrease CVD risk, leading to increased mortality. As seen in this study, the risk of a heart attack cardiovascular event was higher in the fastest eGFR decline, confirming the hypothesis that eGFR is an indicator of how the kidney functions. Therefore, it is crucial to monitor eGFR and prevent cardiovascular events in patients with chronic kidney disease. It is essential to implement an intervention for chronic kidney disease patients to avoid the worsening of their condition and decrease the chances of developing cardiovascular disease. 

Practice pearls:  

  • Rate of renal deterioration based on eGFR is associated with cardiovascular diseases for patients with type 2 diabetes.  
  • eGFR is an essential marker of current renal function and independent of disease progression. 
  • This study reveals that renal decline correlates with high heart failure incidences for patients with type 2 diabetes. 

 

Cabrera, Claudia S., et al. “Impact of Chronic Kidney Disease Progression on Cardiovascular Disease Risk in a Contemporary UK Cohort of Individuals with Diabetes CKD Progression on Cardiovascular Disease Risk.” Kidney International Reports, 2020http://doi:10.1016/j.ekir.2020.07.029  

 

Aleksandra Kusic, PharmD Candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences