Study supports CKD progression as cardiovascular risk predictor in patients with diabetes
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A study of patients with type 2 diabetes demonstrated those who had an increased progression of chronic kidney disease, as measured by eGFR, also had a higher likelihood of experiencing major adverse cardiovascular events.
“Morbidity and mortality in patients with diabetic kidney disease are predominantly due to cardiovascular disease (CVD),” Claudia S. Cabrera, PhD, of AstraZeneca in Gothenburg and Karolinska Institute in Sweden, and colleagues wrote. “Several studies have demonstrated a strong association between CKD and CVD, and additionally this is further pronounced in persons with [type 2 diabetes] T2DM. Less is known about the frequency and characteristics of CKD progression in relation to CVD outcomes and background factors such as hypertensive treatment and concomitant disease.”
Adding that previous studies may have been limited by assumptions that reductions in eGFR remain stable over time, the researchers noted that a study from 2009 was the first to find a link between annual eGFR decline and risk for heart disease.
To further explore the area, Cabrera and colleagues included 30,222 patients from the United Kingdom with type 2 diabetes and newly diagnosed CKD. Within 2-year periods (median follow-up of 4.3 years), patients were stratified according to eGFR slope categories (3 mL/min/1.73 m2, 0 mL/min/1.73 m2 to <3 mL/min/1.73 m2, <0 mL/min/1.73 m2 to -3 mL/min/1.73 m2, -3 mL/min/1.73 m2) and followed until heart failure (HF), myocardial infarction (MI), ischemic stroke (IS) or a composite endpoint including all three event types (MACE plus). Capturing a mean of eleven eGFR values per patient, the researchers determined both the updated eGFR slope and updated mean eGFR were associated with MACE plus and HF. For each eGFR slope decline of less than -3 ml/min/1.73m2, they observed an increase in risk for MACE plus (adjusted HR = 1.45), heart failure (HR = 1.50) and myocardial infarction (HR = 1.39).
Further findings indicated that, in addition to eGFR measures, the strongest independent risk factors for CVD outcomes were age, male gender, smoking status, hypertensive treatment and duration of type 2 diabetes prior to CKD diagnosis.
According to Cabrera and colleagues, this is the first study to assess the associations between both kidney disease progression and current renal status with the development of macro-vascular outcomes independent of other risk factors (eg, hypertension and cardiovascular medications).
“The rate of renal deterioration remained highly correlated with incident HF events in T2DM subjects independently of most current renal health,” the researchers concluded. “This knowledge may be used in future clinical practice to provide more timely medical intervention to prevent CVD in patients with CKD.”
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