Kidney function drives CV outcomes in Type 2 diabetes
medwireNews: Baseline kidney function is the major predictor of cardiovascular (CV) outcomes in sitagliptin-treated patients with Type 2 diabetes, shows an analysis of the TECOS trial.
A total of 14,525 TECOS participants – Type 2 diabetes patients with confirmed atherosclerotic disease – had available baseline estimated glomerular filtration rate (eGFR) measurements. The rate of CV mortality, myocardial infarction, stroke and hospitalisation for unstable angina over a median follow-up of 3 years rose from 3.52 per 100 patient–years among those with stage 1 kidney disease to 7.34 per 100 patient–years among those with stage 3b disease.
After accounting for confounders, this equated to a significant 1.39-fold increased risk, but the elevated risk started at stage 3a kidney disease, with these patients having a significant 1.28-fold increased risk.
Of the individual endpoints, hospitalisation for unstable angina was not significantly associated with baseline kidney function, but all the others were, as was hospitalisation for heart failure. There was a similar, albeit less clear, association between baseline micro/macroalbuminuria and CV outcomes.
TECOS patients were randomly assigned to receive either sitagliptin or placebo in addition to their existing medication, but their treatment assignation was not associated with their risk of CV outcomes.
Rury Holman (University of Oxford, UK) and co-researchers note that average eGFR was slightly lower in sitagliptin-treated patients than among those given placebo throughout the study, but the rate of decline was similar in both groups. Specifically, eGFR fell by 4.0 mL/min per 1.73m2 in the sitagliptin group and by 2.8 mL/min per 1.73m2 in the placebo group, with similar results seen for urinary albumin-to-creatinine ratio (UACR).
“It is uncertain whether these small offsets in eGFR and UACR would have any long-term clinical implications”, the researchers write in Diabetes Care.
Indeed, they note that the study duration “may be relatively short for evaluating the risk of the development of diabetic nephropathy, especially in view of the biphasic change in GFR with initial hyperfiltration followed by a decrease in GFR.”
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