No study has assessed whether the prognosis of coexisting diabetes mellitus and chronic kidney disease (DM- CKD) is dictated by DM per se or by the extent of proteinuria. Methods. In this pooled analysis of four prospective studies in CKD patients treated with drugs inhibiting the renin– angiotensin system, we compared the risk of all-cause mortality, fatal and non-fatal cardiovascular (CV) events and end-stage renal disease (ESRD) between patients with (n 1⁄4 693) and with- out diabetes (n1⁄41481) stratified by proteinuria level (<0.15, 0.15–0.49, 0.5–1 and >1 g/day). Results. The group with DM-CKD was older (69 6 11 versus 65 6 15 years), had a higher body mass index (29.6 6 5.4 ver- sus 27.564.8kg/m2) and systolic blood pressure (143619 versus 136618mmHg), prevalent CV disease (48% versus 29%) and lower estimated glomerular filtration rate (34.5 6 17.9 versus 36.6 6 19.0 mL/min/1.73 m2). During 4.07years of follow-up, there were 466 patients with ESRD, 334 deaths and 401 CV events occurred. In the subgroup with urine protein <0.15g/day (N1⁄4662), the risks of ESRD, CV events and mortality were similar in diabetic and non-diabetic patients. Conversely, in DM-CKD patients, the mortality risk was higher in proteinuric patients {hazard ratio 1.92 [95% confidence interval (CI) 1.25–2.95); 1.99 (1.26–3.15) and 1.98 (1.28–3.06) for proteinuria 0.15–0.49, 0.5–1 and >1g/day, respectively}, whereas in non-diabetics the mortality risk increased only for proteinuria 0.5–1g/day [HR 1.60 (95% CI 1.07–2.40)] and >1 g/day [HR 1.69 (95% CI1.20–2.55)]. In both groups, CV risk had a trend similar to that of mortality. ESRD risk increased progressively across strata >0.5 g/day independent of diabetic status.Conclusions. We provide evidence that patients with non- proteinuric DM-CKD are not exposed to higher cardiorenal risk. In contrast, in the presence of moderate proteinuria and diabetes per se is associated with a higher risk of mortality and CV events, whereas the entity of abnormal proteinuria modu- lates ESRD risk independent of diabetes.
Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies
Santoro, DomenicoInvestigation
;
2018-01-01
Abstract
No study has assessed whether the prognosis of coexisting diabetes mellitus and chronic kidney disease (DM- CKD) is dictated by DM per se or by the extent of proteinuria. Methods. In this pooled analysis of four prospective studies in CKD patients treated with drugs inhibiting the renin– angiotensin system, we compared the risk of all-cause mortality, fatal and non-fatal cardiovascular (CV) events and end-stage renal disease (ESRD) between patients with (n 1⁄4 693) and with- out diabetes (n1⁄41481) stratified by proteinuria level (<0.15, 0.15–0.49, 0.5–1 and >1 g/day). Results. The group with DM-CKD was older (69 6 11 versus 65 6 15 years), had a higher body mass index (29.6 6 5.4 ver- sus 27.564.8kg/m2) and systolic blood pressure (143619 versus 136618mmHg), prevalent CV disease (48% versus 29%) and lower estimated glomerular filtration rate (34.5 6 17.9 versus 36.6 6 19.0 mL/min/1.73 m2). During 4.07years of follow-up, there were 466 patients with ESRD, 334 deaths and 401 CV events occurred. In the subgroup with urine protein <0.15g/day (N1⁄4662), the risks of ESRD, CV events and mortality were similar in diabetic and non-diabetic patients. Conversely, in DM-CKD patients, the mortality risk was higher in proteinuric patients {hazard ratio 1.92 [95% confidence interval (CI) 1.25–2.95); 1.99 (1.26–3.15) and 1.98 (1.28–3.06) for proteinuria 0.15–0.49, 0.5–1 and >1g/day, respectively}, whereas in non-diabetics the mortality risk increased only for proteinuria 0.5–1g/day [HR 1.60 (95% CI 1.07–2.40)] and >1 g/day [HR 1.69 (95% CI1.20–2.55)]. In both groups, CV risk had a trend similar to that of mortality. ESRD risk increased progressively across strata >0.5 g/day independent of diabetic status.Conclusions. We provide evidence that patients with non- proteinuric DM-CKD are not exposed to higher cardiorenal risk. In contrast, in the presence of moderate proteinuria and diabetes per se is associated with a higher risk of mortality and CV events, whereas the entity of abnormal proteinuria modu- lates ESRD risk independent of diabetes.Pubblicazioni consigliate
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