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: 6.88). 05/2007; 50(5):941-8. DOI: 10.1007/s00125-007-0616-1
Source: PubMed

ABSTRACT 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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    PLoS ONE 01/2014; 9(12):e114855. · 3.53 Impact Factor
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    ABSTRACT: Background: The presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR). Methods: This study is a national cross-sectional study performed in primary care consults. We selected participants of both sexes who were aged 40 years or older, had been diagnosed with T2DM and had complete information on the study variables recorded in their medical records. The participants were classified according to eGFR : ≥ 60; 45–59; 30–44; <30 mL/min/1.73 m 2 and UACR : < 30; 30–299; ≥300 mg/gr. The results were adjusted to compare the prevalence of CVD across all categories. Results: A total of 1141 participants were included. Compared to participants with eGFR > 60 mL/min/1.73 m 2 those with eGFR between 30–44 mL/min/m 2 , (OR = 2.3; 95% CI, 1.4-3.9); and eGFR < 30 mL/min/1.73 m 2 (OR = 4.1 95% CI 1.6-10.2) showed increased likelihood of having CVD. Participants with UACR ≥ 30 mg/g compared to participants with UACR < 30 mg/g increased significantly the likelihood of having CVD, especially with UACR above 300 mg/g, (OR = 1.6; 95% CI 1.1-2.4 for UACR = 30–299 mg/g; OR = 3.9; CI 1.6-9.5 for UACR ≥ 300 mg/g). Conclusion: The decrease in eGFR and increase in UACR are independent risk factors that increase the prevalence of CVD in participants with T2DM and these factors are independent of each other and of other known cardiovascular risk factors. In our study the impact of mild decreased eGFR in T2DM on CVD was lower than the impact of increased UACR. It is necessary to determine not only UACR but also eGFR for all patients with T2DM, both at the time of diagnosis and during follow-up, to identify those patients at high risk of cardiovascular complications.
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