Estimated glomerular filtration rate, albuminuria and mortality in type 2 diabetes: The Casale Monferrato study

Department of Internal Medicine, University of Torino, corso Dogliotti 14, I-10126 Torino, Italy.
Diabetologia (Impact Factor: 6.67). 05/2007; 50(5):941-8. DOI: 10.1007/s00125-007-0616-1
Source: PubMed


Estimated glomerular filtration rate (eGFR) predicts mortality in non-diabetic populations, but its role in people with type 2 diabetes is unknown. We assessed to what extent a reduction in eGFR in people with type 2 diabetes predicts 11-year all-cause and cardiovascular mortality, independently of AER and other cardiovascular risk factors.
The study population was the population-based cohort (n = 1,538; median age 68.9 years) of the Casale Monferrato Study. GFR was estimated by the abbreviated Modification of Diet in Renal Disease Study equation.
At baseline, the prevalence of chronic kidney disease (eGFR <60 ml min(-1) 1.73 m(-2)) was 34.3% (95% CI 33.0-36.8). There were 670 deaths in 10,708 person-years of observation. Hazard ratios of 1.23 (95% CI 1.03-1.47) for all-cause mortality and 1.18 (95% CI 0.92-1.52) for cardiovascular mortality were observed after adjusting for cardiovascular risk factors and AER. When five levels of eGFR were analysed we found that most risk was conferred by eGFR 15-29 ml min(-1) 1.73 m(-2), whereas no increased risk was evident in people with eGFR values between 30 and 59 ml min(-1) 1.73 m(-2). In an analysis stratified by AER categories, a significant increasing trend in risk with decreasing eGFR was evident only in people with macroalbuminuria.
Our study suggests that in type 2 diabetes macroalbuminuria is the main predictor of mortality, independently of both eGFR and cardiovascular risk factors, whereas eGFR provides no further information in normoalbuminuric people.

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    • "That measures of kidney disease predicted mortality in a T2D-enriched sample is broadly consistent with the existing literature. A number of investigations have identified the associations of both albuminuria with CVD-mortality and eGFR with CVD-mortality, consistently demonstrating that these were independent associations [11-14,25,26]. Albuminuria and eGFR have also been confirmed to predict all-cause mortality in a recent large meta-analysis using general population cohorts of varying ethnicities [27]. "
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    ABSTRACT: Background Risk stratification in individuals with type 2 diabetes (T2D) remains an important priority in the management of associated morbidity and mortality, including from cardiovascular disease (CVD). The current investigation examined whether estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) were independent predictors of CVD-mortality in European Americans (EAs) with T2D after accounting for subclinical CVD. Methods 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. Results 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. Conclusions The DHS reveals that kidney function and albuminuria are independent risk factors for all-cause mortality and CVD-mortality in EAs with T2D, even after accounting for CAC.
    Cardiovascular Diabetology 04/2013; 12(1):68. DOI:10.1186/1475-2840-12-68 · 4.02 Impact Factor
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    • "The study base included 1,540 type 2 diabetic subjects residing in Casale Monferrato (93,477 inhabitants) in 1991 who were identified through diabetes clinics, general practitioners, hospital discharges, prescriptions, and sales records of reagent strips/syringes (10,11). Electrocardiogram (ECG) records suitable for QTc/QTd evaluation were available for 1,359 (88%) patients (580 male and 779 female). "
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    ABSTRACT: To evaluate the predictive role of increased corrected QT (QTc) and QT interval dispersion (QTd) on all-cause and cardiovascular mortality in a large, unselected type 2 diabetic population. The prospective study included 1,357 type 2 diabetic patients from the Casale Monferrato Study. At baseline, QTc intervals >0.44 s and QTd intervals >0.08 s were considered abnormally prolonged. Both all-cause and cardiovascular mortality were assessed 15 years after the baseline examination. During the follow-up period, 862 subjects per 12,450 person-years died. Multivariate analysis showed that the hazard ratio (HR) of cardiovascular mortality was significantly increased in subjects with prolonged QTd (1.26 [95% CI 1.02-1.55]) and was only slightly reduced after multiple adjustments. Conversely, prolonged QTc did not increase the HRs for all-cause or cardiovascular mortality. Increased QTd predicts cardiovascular mortality after a long-term follow-up period in a large, unselected population of type 2 diabetic subjects.
    Diabetes care 03/2012; 35(3):581-3. DOI:10.2337/dc11-1397 · 8.42 Impact Factor
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    ABSTRACT: Aims To (1) measure urinary albumin and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (DM) in Kanagawa Prefecture, (2) assess the validity of the diabetic nephropathy (DN) stage classification system and current chronic kidney disease (CKD) stage classification system from the Kidney Disease Outcomes Quality Initiative—Kidney Disease: Improving Global Outcomes (K/DOQI-KDIGO), and (3) validate the new CKD stage classification system of KIDIGO 2009. Subjects and methods The Kanagawa Physicians Association conducted a survey across 255 medical institutions over six months and measured urinary creatinine-corrected urinary albumin levels in 4,885 subjects, in addition to height, weight, blood pressure, sex, age, urinalysis, urinary albumin, blood glucose, hemoglobin A1c, and serum creatinine levels. Results In stages 1 and 2 of the DN classification system, many patients with urinary albumin <300 mg/g Cr had low eGFR. More than 1,000 such cases were unclassifiable. Similarly, many patients had inconsistent urinary albumin levels and eGFRs and thus could not be classified. Using the current CKD stage classification system, 735 patients (15.0 %) were unclassifiable as they had normoalbuminuria with stage 1 renal function, and 1,921 patients (about 40 %) were excluded based on normoalbuminuria with stage 2 renal function. However, all patients were successfully classified by the new CKD stage classification system. Conclusions All of the patients were successfully classified by the new CKD stage classification system. However, many patients were elderly and hypertensive and thus likely to have diseases other than DN. Regular monitoring of diabetics for urinary albumin and eGFR should enhance the early detection of DN and enable appropriate intervention.
    Diabetology International 06/2012; 4(2). DOI:10.1007/s13340-012-0099-2
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