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Type 2 diabetes, prior CVD raise risk for CKD
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Adults with long-standing type 2 diabetes and prior cardiovascular disease are more likely to have chronic kidney disease vs. patients without those risk factors, according to an analysis of LEADER trial data.
“We identified advanced age, long diabetes duration, poor glycemic control, comorbidities and medications used as factors significantly associated with CKD at baseline in the LEADER trial population with established CVD,” Ilhan Satman, MD, of the division of endocrinology and metabolic diseases at Istanbul University, told Endocrine Today.
Satman and colleagues analyzed baseline data from participants in the LEADER trial, a study designed to assess the CV safety of Victoza (liraglutide, Novo Nordisk) vs. placebo in patients with type 2 diabetes and high CV risk across 410 centers in 32 countries (n = 9,430). Participants were randomly assigned 1.8 mg liraglutide once daily or a placebo injection as add-on therapy to standard care.
For this analysis, researchers measured baseline data (serum and urine creatinine concentrations and glomerular filtration rate) from a subset of participants aged at least 50 years with prior CVD (n = 7,592; 66.5% men; mean age, 64 years; mean diabetes duration, 12.8 years; mean HbA1c, 8.7%), including prior MI, ischemic heart disease, stroke, transient ischemic attack or arterial revascularization. CKD was defined as an estimated GFR less than 60 mL/min/1.73 m² or an albumin-to-creatinine ratio of at least 3 mg/mmol.
Baseline data revealed more than half of LEADER participants with prior CVD had CKD (51.9%). Prevalence was highest in Asia (75.8%) and lowest in Europe (43.7%) and the Middle East (43.4%). Researchers found that increased age, HbA1c, diabetes duration, systolic blood pressure and triglyceride levels, and a greater number of antihypertensive medications were associated with increased CKD prevalence, as well as not receiving oral antidiabetic drugs (most receiving insulin), beta-blockers or angiotensin-converting enzyme inhibitors. Men and those living in Asia or the Americas vs. Europe also were more likely to have CKD.
Patients who had increased diastolic BP, no diuretic therapy and no prior MI, angina or stroke were less likely to have CKD, according to researchers.
“Based on our results, we strongly recommend early screening and inclusion of high CV risk patients with type 2 diabetes into CKD prevention programs,” Satman said. – by Regina Schaffer
Disclosure: The LEADER trial was funded by Novo Nordisk. Satman reports serving on advisory boards for AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novo Nordisk and Sanofi. Please see the full study for the other authors’ relevant financial disclosures.
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