Kidney function and the risk of cardiovascular disease in patients with type 2 diabetes

Abstract

The association of estimated GFR with cardiovascular diseases risk among type 2 diabetes patients was unclear. We prospectively investigated the race-specific association of estimated GFR with the risk of coronary heart disease and stroke among 11 940 White and 16 451 African American patients. During mean follow up of 6.1–6.8 years, 6 647 coronary heart disease and 2 750 stroke incident cases were identified. Age- and sex-adjusted hazard ratios of coronary heart disease associated with baseline estimated GFR (≥90, 75–89, 60–74, 30–59, and 15–29 mL/min/1.73 m2) were 1.00, 1.04 (95% CI 0.95–1.14), 1.13 (1.02–1.26), 1.37 (1.22–1.53), and 2.07 (1.58–2.71) (Ptrend<0.001) for African Americans, and 1.00, 1.09 (0.99–1.19), 1.10 (0.99–1.21), 1.31 (1.18–1.46), and 2.18 (1.66–2.85) (Ptrend<0.001) for whites, respectively. Significantly increased stroke risk was observed among both African American and white participants with estimated GFR<60 mL/min/1.73 m2. When using the updated mean values of estimated GFR, these significant associations became stronger. Participants with mildly decreased estimated GFR (60–89 mL/min/1.73 m2) during follow-up were also at significantly higher risk of coronary heart disease and stroke. The present study demonstrated that even mildly reduced estimated GFR at baseline (<75 mL/min/1.73 m2) and during follow-up (<90 mL/min/1.73 m2) increased risk of incident coronary heart disease and stroke among both African American and white type 2 diabetes patients.

Association between kidney function and Framingham risk score in an admixed population of Brazil

“…This result is similar to recent studies which reported that subjects without renal dysfunction had a significantly higher cardiovascular risk (Jin et al, 2014;Wang et al, 2014;Ito et al, 2015;Lu et al, 2016). In a cohort study, an inverse correlation (R 2 = -0.291, p<0.01) was found in Japanese patients with obesity and type 2 diabetes without severe renal dysfunction (Ito et al, 2015).…”

“…In addition, our definition of eGFR was limited to a single measurement of serum creatinine on one occasion, not measured during period ≥ 3 months (Andrew et al, 2005). Finally, we did not have information on proteinuria and albuminuria, which may be independent risk factors for CVD outcomes (Wang et al, 2014).…”

“…Instead, eGFR is the most feasible clinical measure of kidney function (KDIGO, 2013). Some studies have demonstrated that reduced eGFR is a predictor of major cardiovascular events (Jin et al, 2014;Wang et al, 2014;Ito et al, 2015;Lu et al, 2016). Jin and contributors (2014) suggested that kidney function was also independently associated with CVD in a Chinese population without CKD (defined as eGFR <60 mL/min/1.73 m²), however their population was approximately 99% Han Yellow race, and conflicting conclusions may be obtained in different populations comprising subjects from other races.…”

“…The FRS allows physicians to estimate the individual 10-year cardiovascular risk by using traditional cardiac risk factors including gender, age, systolic blood pressure, hypertension treatment, diabetes mellitus history, total cholesterol, highdensity lipoprotein cholesterol (HDL-cholesterol) and cigarette smoking (D'Agostino et al, 2008). In addition to traditional cardiovascular risk factors, other factors, as kidney function, are under investigation in association with CVD (Jin et al, 2014;Wang et al, 2014;Lu et al, 2016).…”

Reduced Kidney Function Is Associated With Cardiometabolic Risk Factors, Prevalent and Predicted Risk of Cardiovascular Disease in Chinese Adults: Results From the REACTION Study

“…Some studies demonstrated that mildly renal insufficiency was an independent predictor for association of increased risk and mortality of CVD in the general population 20, 21. In a cohort study of 11 940 Caucasians and 16 451 African‐American type 2 diabetes mellitus patients with 6.1 to 6.8 years of follow‐up, mildly reduced eGFR at baseline (under 75 mL/min per 1.73 m 2 ) or during follow‐up (under 90 mL/min per 1.73 m 2 ) were both associated with increased risk of incident CHD and stroke 5. In contrast, the Framingham Heart Study, during an average of 15 years of follow‐up of 6233 subjects in the US general population, suggested that the association between mild renal insufficiency and CVD is not independent, and appears to be attributed to the co‐occurrence of traditional CVD risk factors with CKD 22.…”