Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

      Highlights

      • A eGFR < 90 mL/min/1.73 m2 was associated with increased mortality risk (p < 0.001).
      • A eGFR < 90 mL/min/1.73 m2 was associated with increased hospitalizations (p < 0.001).
      • Mortality estimated PAR associated with eGFR levels < 60 was significant in DM.
      • Mortality estimated PAR associated with eGFR levels < 60 was significant in CVD.

      Abstract

      Aims

      To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.

      Methods

      A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.

      Results

      Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60 mL/min/1.73 m2 or less was 11.4% (95% CI 4.8–18.3) for all-cause mortality, 9.2% (95% CI 5.3–13.4) for coronary heart disease, and 2.6% (95% CI −1.8 to 7.4) for stroke.

      Conclusions

      Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.

      Keywords

      Abbreviation:

      CKD (chronic kidney disease), GFR (glomerular filtration rate), ACR (albumin-to-creatinine ratio), CVD (cardiovascular disease), CVR (cardiovascular risk), CV (cardiovascular), DM (diabetes mellitus), eGFR (estimated glomerular filtration rate), K/DOQI (Kidney Disease Outcome Quality Initiative), NHANES (National Health and Nutrition Examination Survey), BMI (body mass index), HER (electronic health record), CKD-EPI (chronic kidney disease epidemiology collaboration), STROBE (strengthening the reporting of observational studies in epidemiology), HDL (high density-lipoprotein), LDL (low-density lipoprotein), IDMS (isotope dilution mass spectrometry), CHD (coronary heart disease), ICD (International Classification of Diseases), CIOMS (Council for International Organizations of Medical Sciences), DGSP-CSISP (Committee for Ethics and Clinical Trials of the Center for Public Health Research), PARs (population attributable risks), CI (confidence interval), RR (related relative risks)
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