This article is more than 5 years old. Information may no longer be current.
Acute kidney injury tied to major adverse events, death in type 2 diabetes
Acute kidney injury, low estimated glomerular filtration rate and abnormal albuminuria in adults with type 2 diabetes are strong predictors of major adverse outcomes and deaths, including cancer and infection-related deaths, according to research in Diabetes Care.
Mathilde Monseu, of Universite de Poitiers in France, and colleagues analyzed data from 1,371 adults with type 2 diabetes (58% men) participating in the SURDIAGENE study, a French cohort of patients who had not undergone renal transplantation or dialysis.
Participants in the cohort were prospectively analyzed for all-cause death (including cancer and infection-related), major cardiovascular and cerebrovascular events, and renal failure, either sustained during a doubling of serum creatinine level or end-stage renal disease, using hospital records, French death certificate registries, biochemical data and interviews with patients’ general practitioners.
During a mean follow-up period of 69 months, 411 participants developed at least one acute kidney injury episode in a hospital setting; 79 patients experienced renal failure; 281 participants died. Those who experienced acute kidney injury were more likely to be older men with a longer duration of diabetes, a lower eGFR and more frequent CV history.
Researchers found that patients who experienced acute kidney injury had a lower survival rate than those than who did not (P < .0001), and that survival rates were significantly lower in patients with stage II or stage III acute kidney injury when compared with those with stage I.
In multivariate analysis, the presence of acute kidney injury, when added to established risk factors, also was a “powerful predictor of major adverse [CV] events, heart failure requiring hospitalization, [myocardial infarction], stroke, lower limb amputation or revascularization and carotid artery revascularization,” according to researchers.
Albuminuria and eGFR were inconsistently associated with all major CV outcomes, although acute kidney injury, eGFR and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and CV deaths, the researchers wrote.
“We observed for the first time that [acute kidney injury] predicted the risk for all-cause death and [CV] death in a cohort specifically dedicated to patients with type 2 diabetes,” the researchers wrote. “To the best of our knowledge, our study is also the first to demonstrate a strong and robust relationship between [acute kidney injury] and noncardiovascular death. Surprisingly, we found that [acute kidney injury] was associated with cancer-related and infection-related death.”
The researchers noted that acute kidney injury may be associated with inflammation, possibly leading to systemic consequences, although the exact mechanism explaining the association between acute kidney injury and major adverse outcomes remains unknown. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.