Prediabetes increases risk for proteinuria progression, CV events
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A large cohort of adults with chronic kidney disease, those with prediabetes were more likely to develop proteinuria or experience a cardiovascular event during 7 years of follow-up compared with those with normoglycemia, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“It is well known that, in patients with chronic kidney disease, diabetes is a risk factor for CV events and CKD progression,” João Sérgio Neves, MD, a fellow of endocrinology at Centro Hospitalar Universitário de São João in Portugal, told Healio. “From a clinical perspective, our study highlights that clinicians taking care of patients with CKD should be aware that prediabetes is also associated with an increased risk of adverse CV outcomes, especially heart failure, and may also increase the of proteinuria progression.”
Neves and colleagues analyzed data from 3,701 adults participating in the Chronic Renal Insufficiency Cohort (CRIC) categorized as having normoglycemia (n = 945; 47.1% women; mean age, 54 years; 29.5% black), prediabetes (n = 847; 46.4% women; mean age, 59 years; 45.3% black) or diabetes (n = 1,909; 44.3% women; mean age, 60 years; 45.1% black) according to fasting plasma glucose, HbA1c and treatment with diabetes therapies at baseline. Researchers used Cox proportional hazards models to estimate HRs for the association of prediabetes and diabetes with a composite renal outcome of end-stage renal disease, a 50% decline in estimated glomerular filtration rate to 15 mL/min/1.73 m2 or less, or a doubling of urine protein-to-creatinine ratio to 0.22 g/g creatinine or greater, and a composite CV outcome of congestive heart failure, myocardial infarction or stroke, and all-cause mortality. Median follow-up was 7.5 years.
Researchers found that prediabetes was not associated with the composite renal outcome, but was associated with proteinuria progression, with an adjusted HR of 1.23 vs. participants with normoglycemia (95% CI, 1.03-1.47). Prediabetes was associated with a 38% higher risk for experiencing the composite CV outcome vs. normoglycemia (adjusted HR = 1.38; 95% CI, 1.05-1.82). Participants with diabetes had an increased risk for the composite renal outcome, the composite CV and all-cause mortality.
“In people with CKD, prediabetes was not associated with a decline in eGFR or development of end-stage renal disease, but was associated with an increased risk of proteinuria progression and adverse CV outcomes,” Neves said.
“The past decade was remarkable for understanding of cardiorenal interactions and the development of newer cardiovascular drugs that included SGLT2 inhibitors and angiotensin receptor neprilysin inhibitors,” Simon Correa MD, MMSc, a postdoctoral research fellow at Brigham and Women’s Hospital Renal Division and Harvard Medical School, told Healio. “Such therapies have been shown to reduce adverse CV events in people with heart failure with reduced ejection fraction and type 2 diabetes. Whether such therapies are efficacious at reducing adverse CV events in people with CKD and prediabetes remains unknown. This is a ripe area for future research.” – by Regina Schaffer
For more information:
Simon Correa MD, MSc, can be reached at Brigham and Women’s Hospital, Renal Division, 75 Francis St., Boston, MA 02115; email: scorreagaviria@bwh.harvard.edu.
João Sérgio Neves, MD, can be reached at Hospital de São João, 9623, 4200-450 Porto, Portugal; email: joaosergioneves@gmail.com.
Disclosures: The authors report no relevant financial disclosures.
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