ACR refines eGFR-related mortality risk in type 2 diabetes patients
medwireNews: A combination of elevated urinary albumin excretion and decreased estimated glomerular filtration rate (eGFR) is associated with increased mortality risk among insulin-treated patients with type 2 diabetes, study findings indicate.
As reported at the 54th EASD Annual Meeting in Berlin, Germany, Uchenna Chidi Anyanwagu (University of Nottingham, UK) and colleagues categorized 18,227 UK primary care patients into four groups according to whether they had high or low eGFR (≥60 and <60 mL/min per 1.73 m2, respectively) and a high or low urinary albumin-to-creatinine ratio (ACR; ≥300 and <300 mg/g, respectively).
Overall, people with high eGFR had a lower mortality risk than people with low eGFR, irrespective of ACR, over a maximum 5 years of follow-up. Mortality rates per 1000 person–years were lowest among patients with high eGFR and low ACR, at 8.1, rising to 9.7 among those with high eGFR and high ACR, and to 19.5 for those with low eGFR and low ACR. Patients with low eGFR and high ACR had the highest mortality rate, at 21.7 per 1000 person–years.
When patients with low eGFR and high ACR were used as a reference group, those in the high eGFR–high ACR group had a significant 20% lower mortality risk after adjustment for factors including age, sex, diabetes duration and blood pressure, while those in the high eGFR–low ACR group had a significant 28% lower risk. Patients in the low eGFR–low ACR group had a numerically lower mortality risk than those in the reference group, but the difference did not reach statistical significance.
These findings “support the hypothesis that eGFR and ACR provide synergistic insights into the association between diabetic kidney disease and total mortality risk” among insulin-treated patients with type 2 diabetes, a group “at high risk of cardiovascular disease and mortality,” said Anyanwagu.
“In view of the recent advances in the management of CVD [cardiovascular disease] and proteinuria, our study provides insight to identify and prognosticate high-risk patients to receive additional cardioprotective management strategy,” he added.
Anyanwagu cautioned, however, that their investigation did not include any information on patients’ ethnicity, and they were not able to adjust for treatment adherence, insulin titration protocols, or changes in medication that occurred after baseline.
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