Risk of cardiovascular disease, death, and renal progression in diabetes according to albuminuria and estimated glomerular filtration rate - 10/03/23

Doi : 10.1016/j.diabet.2023.101420

Jingya Niu ^1,^2,^3,^{⁎
Drs Jingya Niu, Xiaoyun Zhang, Mian Li, Shujing Wu, and Ruizhi Zheng contributed equally.}, Xiaoyun Zhang ^1,^2,^{⁎
Drs Jingya Niu, Xiaoyun Zhang, Mian Li, Shujing Wu, and Ruizhi Zheng contributed equally.}, Mian Li ^1,^2,^{⁎
Drs Jingya Niu, Xiaoyun Zhang, Mian Li, Shujing Wu, and Ruizhi Zheng contributed equally.}, Shujing Wu ^1,^2,^{⁎
Drs Jingya Niu, Xiaoyun Zhang, Mian Li, Shujing Wu, and Ruizhi Zheng contributed equally.}, Ruizhi Zheng ^1,^2,^{⁎
Drs Jingya Niu, Xiaoyun Zhang, Mian Li, Shujing Wu, and Ruizhi Zheng contributed equally.}, Li Chen ⁴, Yanan Huo ⁵, Min Xu ^1,², Tiange Wang ^1,², Zhiyun Zhao ^1,², Shuangyuan Wang ^1,², Hong Lin ^1,², Guijun Qin ⁶, Li Yan ⁷, Qin Wan ⁸, Lulu Chen ⁹, Lixin Shi ¹⁰, Ruying Hu ¹¹, Xulei Tang ¹², Qing Su ¹³, Xuefeng Yu ¹⁴, Yingfen Qin ¹⁵, Gang Chen ¹⁶, Zhengnan Gao ¹⁷, Guixia Wang ¹⁸, Feixia Shen ¹⁹, Zuojie Luo ¹⁵, Yuhong Chen ^1,², Yinfei Zhang ²⁰, Chao Liu ²¹, Youmin Wang ²², Shengli Wu ²³, Tao Yang ²⁴, Qiang Li ²⁵, Yiming Mu ²⁶, Jiajun Zhao ²⁷, Yufang Bi ^1,², Guang Ning ^1,², Weiqing Wang ^1,^2,^⁎ , Jieli Lu ^1,^2,^⁎ , Yu Xu ^1,^2,^⁎
for the China Cardiometabolic Disease and Cancer Cohort (4C) Study Group^{^#}
The 4C Study Group members are listed at the end of the article.
¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
³ Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
⁴ Qilu Hospital of Shandong University, Jinan, China
⁵ Jiangxi People's Hospital, Nanchang, China
⁶ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
⁷ Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
⁸ The Affiliated Hospital of Southwest Medical University, Luzhou, China
⁹ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
¹⁰ Affiliated Hospital of Guiyang Medical College, Guiyang, China
¹¹ Zhejiang Provincial Center for Disease Control and Prevention, China
¹² The First Hospital of Lanzhou University, Lanzhou, China
¹³ Xinhua Hospital Affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China
¹⁴ Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
¹⁵ The First Affiliated Hospital of Guangxi Medical University, Nanning, China
¹⁶ Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
¹⁷ Dalian Municipal Central Hospital, Dalian, China
¹⁸ The First Hospital of Jilin University, Changchun, China
¹⁹ The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
²⁰ Central Hospital of Shanghai Jiading District, Shanghai, China
²¹ Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
²² The First Affiliated Hospital of Anhui Medical University, Hefei, China
²³ Karamay Municipal People's Hospital, Xinjiang, China
²⁴ The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
²⁵ The Second Affiliated Hospital of Harbin Medical University, Harbin, China
²⁶ Chinese People's Liberation Army General Hospital, Beijing, China
²⁷ Shandong Provincial Hospital affiliated to Shandong University, Jinan, China

^$Corresponding Author: Yu Xu, MD, PhD, Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, ChinaShanghai National Clinical Research Center for Metabolic DiseasesRuijin HospitalShanghai Jiaotong University School of Medicine197 Ruijin 2nd RoadShanghai200025China^$$Jieli Lu, MD, PhD, Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, ChinaShanghai National Clinical Research Center for Metabolic DiseasesRuijin HospitalShanghai Jiaotong University School of Medicine197 Ruijin 2nd RoadShanghai200025China^$$$Weiqing Wang, MD, PhD, Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, ChinaShanghai National Clinical Research Center for Metabolic DiseasesRuijin HospitalShanghai Jiaotong University School of Medicine197 Ruijin 2nd RoadShanghai200025China

Highlights

•	More than half of DM patients with reduced eGFR had normal ACR levels in China.
•	Non-albuminuria DKD patients showed increased risks of mortality and MACEs.
•	Risks of MACEs and mortality were more evident in non-albuminuria DKD aged <65 years.
•	Non-albuminuria DKD did not significantly increase the risk of CKD progression.
•	DM patients with albuminuria are at higher risks than those with non-albuminuria DKD.

Le texte complet de cet article est disponible en PDF.

Abstract

Aim

We aimed to examine risks of major cardiovascular events (MACEs), renal outcomes, and all-cause mortality in type 2 diabetes mellitus (T2DM) patients with different diabetic kidney disease (DKD) subtypes.

Methods

A total of 36,509 participants with T2DM recruited from 20 community sites across mainland China were followed up during 2011-2016. DKD subtypes were categorized based on albuminuria (urinary albumin-to-creatinine ratio, UACR ≥ 30 mg/g) and reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m²) as Alb⁻/eGFR⁻, Alb⁺/eGFR⁻, Alb⁻/eGFR⁺, and Alb⁺/eGFR⁺. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of developing clinical outcomes in DKD subtypes.

Results

More than half (53.5%) of participants with diabetes and reduced eGFR had normal UACR levels (Alb⁻/eGFR⁺), termed as non-albuminuria DKD. These patients had a modest increase in the risks of MACEs (hazard ratio, HR 1.42 [95% CI 1.08;1.88]) and mortality (HR 1.42 [1.04;1.92]) compared with patients without DKD, whereas CKD progression was not significantly increased (HR 0.97 [0.60;1.57]). Participants with albuminuria (Alb⁺/eGFR⁻ or Alb⁺/eGFR⁺) had higher risks of clinical outcomes. Subgroup analysis revealed that the associations between non-albuminuria DKD and risks of MACEs and mortality were more evident in those aged <65 years.

Conclusion

Non-albuminuria DKD accounts for more than half of DKD cases with low eGFR in Chinese diabetes patients. Diabetes patients with albuminuria are at higher risks of developing clinical outcomes and warrant early intervention, as well as patients with non-albuminuria DKD with age < 65 years.

Le texte complet de cet article est disponible en PDF.

Keywords : Albuminuria, Chronic kidney disease progression, Diabetic kidney disease, Glomerular filtration rate, Major cardiovascular event, Mortality

Abbreviations : 4C, ACCORD, ADVANCE, Alb, BP, CI, CKD, CKD-EPI, CK-MB, CRIC, CVD, DKD, ESRD, eGFR, GFR, HbA1c, HDL, HR, LDL, JDDM, MACE, NHANES, OGTT, RAAS, RIACE, SD, T2DM, UACR

Plan

Data sharing statement

The 4C Study Group Members

Export

Vol 49 - N° 2

Article 101420- mars 2023 Retour au numéro

Article précédent

Empagliflozin cardiovascular and renal effectiveness and safety compared to dipeptidyl peptidase-4 inhibitors across 11 countries in Europe and Asia: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study
Avraham Karasik, Stefanie Lanzinger, Elise Chia-Hui Tan, Daisuke Yabe, Dae Jung Kim, Wayne H-H Sheu, Cheli Melzer-Cohen, Reinhard W. Holl, Kyoung Hwa Ha, Kamlesh Khunti, Francesco Zaccardi, Anuradhaa Subramanian, Krishnarajah Nirantharakumar, Thomas Nyström, Leo Niskanen, Majken Linnemann Jensen, Fabian Hoti, Riho Klement, Anouk Déruaz-Luyet, Moe H. Kyaw, Lisette Koeneman, Dorte Vistisen, Bendix Carstensen, Sigrun Halvorsen, Gisle Langslet, Soulmaz Fazeli Farsani, Elisabetta Patorno, Júlio Núñez, EMPRISE Europe and Asia Study Group

| Article suivant

Dulaglutide and insulin microsecretion in people with type 1 diabetes (DIAMOND-GLP-1): A randomized double-blind placebo-controlled trial
Charles Thivolet, Etienne Larger, Bertrand Cariou, Eric Renard, Hélène Hanaire, Pierre-Yves Benhamou, Bruno Guerci, Émilie Mathiotte, Karim Chikh

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Risk of cardiovascular disease, death, and renal progression in diabetes according to albuminuria and estimated glomerular filtration rate - 10/03/23

Highlights

Abstract

Aim

Methods

Results

Conclusion

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL