Chronic kidney disease prevalence and cardiovascular risk in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (Spain). An observational study

Published:December 12, 2020DOI:


      • The prevalence of CKD in patients with DM2 was 24.3% (35.1% in women, 12.4% in men).
      • DM2 and CKD patients had a higher percentage of cardiovascular events and mortality.
      • CKD doubles risk of coronary events in DM2 patients (HR: 2.18; 95% CI: 1.13–4.22).
      • Systematic determination of eGFR would contribute to earlier diagnosis of CKD.



      To estimate the prevalence of chronic kidney disease (CKD), their risk factors the incidence of cardiovascular and coronary events and total and cardiovascular mortality in a cohort of type 2 diabetes (T2DM) patients observed for 10 years in primary care practices in Badajoz, Spain.


      Observational, longitudinal study. A total of 643 patients with T2DM (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease, were studied. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at the beginning of the study, by applying the simplified Modification of Diet in Renal Disease (MDRD) Study formula.


      The prevalence rate of CKD was 24.3%. Patients with CKD had higher percentages of coronary, cerebrovascular and cardiovascular events and higher rates of cardiovascular mortality (18.6 vs. 6.0%, p < 0.001) and total mortality (42.3 vs. 23.4%, p < 0.01), compared to patients without CKD. The Cox proportional hazards model, adjusted for age, systolic blood pressure levels, glycated haemoglobin, total cholesterol, obesity and smoking, revealed that patients with CKD had an increased risk of coronary events (HR:2.18; 95% CI:1.13−4.22, p < 0.05).


      Our study confirms a high prevalence of CKD in patients with T2DM and its relationship with the presence of cardiovascular disease.


      BMI (body mass index), CKD (chronic kidney disease), DBP (diastolic blood pressure), DM (diabetes mellitus), T1DM (Type 1 diabetes mellitus), T2DM (Type 2 diabetes mellitus), eGFR (estimated glomerular filtration rate), ESRD (end-stage renal disease), GFR (glomerular filtration rate), HDL-cholesterol (high density lipoprotein cholesterol), LDL-cholesterol (Low density lipoprotein cholesterol), MDRD (Modification of Diet in Renal Disease study), SBP (systolic blood pressure), SD (Standard deviation)


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        • Levey A.S.
        • Atkins R.
        • Coresh J.
        • et al.
        Chronic kidney disease as a global public health problem: approaches and initiatives — a position statement from kidney disease improving global outcomes.
        Kidney Int. 2007; 72: 247-259
        • American Diabetes Association
        Microvascular complications and foot care: standards of medical care in diabetes-2019.
        Diabetes Care. 2019; 42: S124-S138
        • Tuttle K.R.
        • Stein J.H.
        • DeFronzo R.A.
        The natural history of diabetic nephropathy.
        Semin. Nephrol. 1990; 10: 184-193
        • Afkarian M.
        • Zelnick L.R.
        • Hall Y.N.
        • et al.
        Clinical manifestations of kidney disease among US adults with diabetes, 1988–2014.
        JAMA. 2016; 316: 602-610
        • Perkins B.A.
        • Ficociello L.H.
        • Roshan B.
        • et al.
        In patients with type 1 diabetes and new-onset microalbuminuria, the development of advanced chronic kidney disease may not require progression to proteinuria.
        Kidney Int. 2010; 77: 57-64
        • Molitch M.E.
        • Steffes M.
        • Sun W.
        • et al.
        epidemiology of diabetes interventions and complications study group. Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study.
        Diabetes Care. 2010; 33: 1536-1543
        • Kramer H.J.
        • Nguyen Q.D.
        • Curhan G.
        • et al.
        Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus.
        JAMA. 2003; 289: 3273-3277
        • Thomas M.C.
        • Macisaac R.J.
        • Jerums G.
        • et al.
        Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (national evaluation of the frequency of renal impairment Co-existing with NIDDM [NEFRON] 11).
        Diabetes Care. 2009; 32: 1497-1502
        • de Boer I.H.
        • Afkarian M.
        • Rue T.C.
        • et al.
        diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) research group. Renal outcomes in patients with type 1 diabetes and macroalbuminuria.
        J. Am. Soc. Nephrol. 2014; 25: 2342-2350
        • Tuttle K.R.
        • Bakris G.L.
        • Bilous R.W.
        • et al.
        Diabetic kidney disease: a report from an ADA Consensus Conference.
        Diabetes Care. 2014; 37: 2864-2883
        • de Boer I.H.
        • Rue T.C.
        • Hall Y.N.
        • et al.
        Temporal trends in the prevalence of diabetic kidney disease in the United States.
        JAMA. 2011; 305: 2532-2539
        • de Boer I.H.
        DCCT/EDIC research group. Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.
        Diabetes Care. 2014; 37: 24-30
        • Martínez-Castelao A.
        • de Alvaro F.
        • Górriz J.L.
        Epidemiology of diabetic nephropathy in Spain.
        Kidney Int. 2005; 99: S20-S24
        • Redón J.
        • Morales-Olivas F.
        • Galgo A.
        • et al.
        Urinary albumin excretion and glomerular filtration rate across the spectrum of glucose abnormalities in essential hypertension.
        J. Am. Soc. Nephrol. 2006; 17: S236-S245
        • Gómez P.
        • Ruilope L.M.
        • Barrios V.
        • et al.
        Prevalence of renal insufficiency in individuals with hypertension and obesity/ overweight: the FATH study.
        J. Am. Soc. Nephrol. 2006; 17: S194-S200
        • De Pablos-Velasco P.L.
        • Ampudia-Blasco F.J.
        • Cobos A.
        • Bergonon S.
        • en representación del Grupo de Investigadores DIABIR
        Estimated prevalence of chronic renal failure among patients with type 2 diabetes in Spain.
        Med. Clin. (Barc). 2010; 134: 340-345
        • Lou Arnal L.M.
        • Campos Gutiérrez B.
        • Cuberes Izquierdo M.
        • et al.
        Grupo de Investigación ERC Aragón. Prevalencia de enfermedad renal crónica en pacientes con diabetes tipo 2 atendidos en atención primaria.
        Nefrología. 2010; 30: 552-556
        • Coll-de-Tuero G.
        • Mata-Cases M.
        • Rodriguez-Poncelas A.
        • et al.
        Chronic kidney disease in the type 2 diabetic patients: prevalence and associated variables in a random sample of 2642 patients of a Mediterranean area.
        BMC Nephrol. 2012; 13: 87-96
        • Rodriguez-Poncelas A.
        • Garre-Olmo J.
        • Franch-Nadal J.
        • et al.
        Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study.
        BMC Nephrol. 2013; 14: 46-56
        • Mur Martí T.
        • Villaró Gabarrós M.
        • Porta Martínez N.
        • Jaén Manzanera A.
        Prevalencia de enfermedad renal crónica en pacientes con diabetes tipo 2 mediante determinación del filtrado glomerular y su relación con el riesgo cardiovascular.
        Med. Clin. (Barc). 2013; 140: 395-400
        • Parving H.H.
        • Lewis J.B.
        • Ravid M.
        • et al.
        Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective.
        Kidney Int. 2006; 69: 2057-2063
        • Saran R.
        • Li Y.
        • Robinson B.
        • et al.
        US renal data system 2015 annual data report: epidemiology of kidney disease in the United States.
        Am. J. Kidney Dis. 2016; 67 (S1_S305)
        • Fox C.S.
        • Matsushita K.
        • Woodward M.
        • et al.
        Chronic kidney disease prognosis consortium. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.
        Lancet. 2012; 380: 1662-1673
        • Grundy S.M.
        Diabetes and coronary risk equivalency: what does it mean?.
        Diabetes Care. 2006; 29: 457-460
        • Matsushita K.
        • van der Velde M.
        • Astor B.C.
        • et al.
        Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.
        Lancet. 2010; 375: 2073-2081
        • Sarwar N.
        • Gao P.
        • Seshasai S.R.
        • et al.
        for the Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.
        Lancet. 2010; 375: 2215-2222
        • Reiner Z.
        • Catapano A.L.
        • de Backer G.
        • et al.
        European Association for Cardiovascular Prevention & Rehabilitation; ESC Committee for Practice Guidelines (CPG) 2008–2010 and 2010–2012 Committees. ESC/EAS Guidelines for The management of dyslipidaemias: The Task Force for The management of dyslipidaemias of The European Society of Cardiology (ESC) and The European Atherosclerosis Society (EAS).
        Eur. Heart J. 2011; 32: 1769-1818
        • Tonelli M.
        • Muntner P.
        • Lloyd A.
        • et al.
        Alberta Kidney Disease Network. Risk of coronary events in people with chronic Kidney Disease compared with those with diabetes: a population level cohort study.
        Lancet. 2012; 380: 807-814
        • Saydah S.H.
        • Eberhardt M.S.
        • Loria C.M.
        • Brancati F.L.
        Age and the burden of death attributable to diabetes in the United States.
        Am. J. Epidemiol. 2002; 156: 714-719
        • Cosentino F.
        • Grant P.J.
        • Aboyans V.
        • et al.
        ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD.
        Eur. Heart J. 2019; 41: 255-323
        • The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Report of the expert committee on the diagnosis and classification of diabetes mellitus.
        Diabetes Care. 1997; 20: 1183-1197
      1. Informe Encuesta Europea de Salud, Ministerio de Sanidad, Servicios Sociales e Igualdad, 2014, Available at: (Accessed 2 November 2020).

        • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group
        KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.
        Kidney Int. 2013; 3: S1-S150
      2. National kidney foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am. J. Kidney Dis. 2002; 39: S1-S266
        • Vervoort G.
        • Willems H.L.
        • Wetzels J.F.M.
        Assessment of glomerular filtration rate in healthy subjects and normoalbuminuric diabetic patients: validity of a new (MDRD) prediction equation.
        Nephrol. Dial. Transplant. 2002; 17: 1909-1913
        • Calvo Hueros J.I.
        • Morales Gabardino J.A.
        • Cañón Barroso L.
        • et al.
        Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (Spain). An observational study.
        Prim. Care Diabetes. 2020; (in press)
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Dubois D.
        • Dubois E.F.
        A formula to estimate the approximate surface area if height and weight be known.
        Arch. Intern. Med. 1916; 17: 863-871
        • Hailpern S.M.
        • Cohen H.W.
        • Alderman M.H.
        Renal dysfunction and ischemic heart disease mortality in a hypertensive population.
        J. Hypertens. 2005; 23: 1809-1816
        • Cosín-Aguilar J.
        • Hernándiz-Martínez A.
        • Arístegui-Urrestarazu R.
        • et al.
        Coronary disease risk and prevalence of heart disease in primary care patients with hypertension and renal disease.
        Rev. Esp. Cardiol. 2006; 59: 1026-1032
        • New J.P.
        • Middleton R.J.
        • Klebe C.K.
        • et al.
        Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice.
        Diabet. Med. 2007; 24: 364-369
        • van der Meer V.
        • Wielders H.P.
        • Grootendorst D.C.
        • et al.
        Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice.
        Br. J. Gen. Pract. 2010; 60: 884-890
        • Porrini E.
        • Ruggenenti P.
        • Mogensen C.E.
        • et al.
        ERA-EDTA diabesity working group. Non-proteinuric pathways in loss of renal function in patients with type 2 diabetes.
        Lancet Diabetes Endocrinol. 2015; 3: 382-391
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • et al.
        Chronic kidney disease and the risk of death, cardiovascular events, and hospitalization.
        N. Engl. J. Med. 2004; 351: 1296-1305
        • Shara N.M.
        • Wang H.
        • Valaitis E.
        • et al.
        Comparison of estimated glomerular filtration rates and albuminuria in predicting risk of coronary heart disease in a population with high prevalence of diabetes mellitus and renal disease.
        Am. J. Cardiol. 2011; 107: 399-405
        • Schiffrin E.L.
        • Lipman M.L.
        • Mann J.F.
        Chronic kidney disease: effects on the cardiovascular system.
        Circulation. 2007; 116: 85-97
        • Bogers R.P.
        • Bemelmans W.J.E.
        • Hoogenveen R.T.
        • et al.
        for the BMI-CHD Collaboration Investigators. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels. A meta-analysis of 21 cohort studies including more than 300.000 persons.
        Arch. Intern. Med. 2007; 167: 1720-1728
        • Pugliese G.
        • Solini A.
        • Bonora E.
        • et al.
        The chronic kidney disease epidemiology collaboration (CKD-EPI) equation provides a better definition of cardiovascular burden associated with CKD than the modification of diet in renal disease (MDRD) study formula in subjects with type 2 diabetes.
        Atherosclerosis. 2011; 218: 194-199
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann. Intern. Med. 2009; 150: 604-612