Xue-Lian Zhang 1 , Ming-Xia Yuan 1 , Gang Wan 2 , Guang-Ran Yang 1 , Dong-Mei Li 3 , Han-Jing Fu 1 , Liang-Xiang Zhu 1 , Rong-Rong Xie 1 , Jian-Dong Zhang 4 , Yu-Jie Lv 5 , Yu-Ling Li 6 , Xue-Ping Du 7 , Zi-Ming Wang 8 , Xue-Li Cui 9 , De-Yuan Liu 10 , Ying Gao 11 , Shu-Yan Cheng 12 , Qian Wang 13 , Yu Ji 14 , Guang-Wei Li 15 , 16 , Shen-Yuan Yuan 1
31 August 2018
It is well known that diabetic kidney disease is a risk factor for cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM). In this study, the effects of urine albumin excretion rate (AER) and estimated glomerular filtration rate (eGFR) on CVD outcomes were analyzed in a population of T2DM.
The study was carried out using recorded information of a cohort study. A total of 1,914 patients with T2DM with no prevalent CVD were enrolled in an 8 years prospective study and received multifactorial intervention. The risk of CVD outcomes was assessed according to chronic kidney disease staging, which was categorized using AER (mg/d) and eGFR (mL/min/1.73 m 2). The effects of AER and eGFR on risk of CVD onset were also analyzed.
During the follow-up period (median 6.8 years), 71 CVD events occurred. At baseline, those with AER ≥300 mg/d and coexisting eGFR 60–89 mL/min/1.73 m 2 or <60 mL/min/1.73 m 2 showed increased risk for CVD outcomes when compared with “no chronic kidney disease” (AER <30 mg/d and eGFR ≥90 mL/min/1.73 m 2). The increased CVD risk was observed in patients who progressed to AER ≥30 mg/d during the follow-up period, whereas patients who progressed to eGFR <90 mL/min/1.73 m 2 alone showed no increased CVD risk. During the follow-up period, after multifactorial intervention, 8.7% patients with microalbuminuria and 1.8% patients with overt nephropathy reversed to normoalbuminuria or microalbuminuria.