Risk of cardiovascular disease, death, and renal progression in diabetes according to albuminuria and estimated glomerular filtration rate

作者：Niu, Jingya; Zhang, Xiaoyun; Li, Mian; Wu, Shujing; Zheng, Ruizhi; Chen, Li; Huo, Yanan; Xu, Min; Wang, Tiange; Zhao, Zhiyun; Wang, Shuangyuan; Lin, Hong; Qin, Guijun; Yan, Li; Wan, Qin; Chen, Lulu; Shi, Lixin; Hu, Ruying; Tang, Xulei; Su, Qing; Yu, Xuefeng; Qin, Yingfen; Chen, Gang; Gao, Zhengnan; Wang, Guixia; Shen, Feixia; Luo, Zuojie; Chen, Yuhong; Zhang, Yinfei; Liu, Chao; Wang, Youmin; Wu, Shengli; Yang, Tao; Li, Qiang; Mu, Yiming; Zhao, Jiajun; Bi, Yufang; Ning, Guang; Wang, Weiqing

来源：Diabetes and Metabolism, 2023, 49(2): 101420.

DOI：10.1016/j.diabet.2023.101420

• Albuminuria
• Chronic kidney disease progression
• Diabetic kidney disease
• Glomerular filtration rate
• Major cardiovascular event
• Mortality

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 diabe-tes patients. Diabetes patients with albuminuria are at higher risks of developing clinical outcomes and war-rant early intervention, as well as patients with non-albuminuria DKD with age < 65 years.

• 单位
  山东大学; 上海大学; 中山大学; y; 上海交通大学; 兰州大学; 1; 哈尔滨医科大学; 郑州大学; 安徽医科大学; 华中科技大学; 吉林大学