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Glomerular Filtration Rate and Albuminuria Predict Mortality

Risk stratification in individuals with type 2 diabetes remains an important priority in the management of associated morbidity and mortality….

The current investigation examined whether estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) were independent predictors of cardiovascular disease (CVD) mortality in European Americans (EAs) with type 2 diabetes after accounting for subclinical CVD.

The family-based Diabetes Heart Study (DHS) cohort (n=1,220) had baseline measures of serum creatinine, eGFR, UACR and coronary artery calcified plaque (CAC) assessed by non-contrast computed tomography scan. Cox proportional hazards regression was performed to determine risk for all-cause mortality and CVD-mortality associated with indices of kidney disease after accounting for traditional CVD risk factors and CAC as a measure of subclinical CVD.

Participants were followed for 8.2±2.6 years (mean±SD) during which time 247 (20.9%) were deceased, 107 (9.1%) from CVD. Univariate analyses revealed positive associations between serum creatinine (HR:1.56; 95% CI:1.37–1.80; p<0.0001) and UACR (1.59; 1.43–1.77; p>0.0001) and negative associations between serum albumin (0.74; 0.65–0.84; p<0.0001) and eGFR (0.66; 0.58–0.76; p<0.0001) with all-cause mortality. Associations remained significant after adjustment for traditional CVD risk factors, as well as for CAC. Similar trends were noted when predicting risk for CVD-mortality.

In conclusion, this study was an extension of our prior observations of independent relationships between albuminuria and CAC, and between CAC and mortality, and examined whether indices of kidney disease were predictive of mortality in EAs with T2D after considering the risk conferred by the presence of subclinical CVD. These results provide further support for the utility of routine clinical indices of kidney function and proteinuria in the prediction of mortality, independent from subclinical CVD and in the absence of more direct measures of CVD burden. As UACR is a modifiable risk factor and treatments exist for slowing the rate of eGFR decline, this information is clinically useful for risk stratification along with management of traditional CVD risk factors in EA T2D-affected individuals.

Cardiovasc Diabetol. 2013;12(68)