Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: Association with chronic kidney disease
Journal of Diabetes and Its Complications 2015
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Aims: To assess the prevalence of stage 3–5 chronic kidney disease (CKD) at baseline and to identify associated risk factors. To determine the effect of CKD and CKD stage according to estimated glomerular filtration rate (eGFR) and albuminuria categories on all-cause and cardiovascular mortality after a 5-year follow-up.
Methods: Prospective cohort study of 3443 outpatients with type 2 diabetes mellitus.
Results: The prevalence of CKD was 28.32% (95% CI, 26.84–29.86); and variables most strongly associated
were: age N74 years (OR, 19.88; 95% CI, 12.89–30.68) and albuminuria (OR, 2.27; 95% CI, 1.72–3.00).
During follow-up, 221 CKD patients (22.90%) died compared with 203 non-CKD patients (8.31%) (p b 0.01).
The adjusted HR of CKD for cardiovascular and all-cause mortality was 1.82 (95% CI, 1.36–2.44) and 2.11 (95%CI, 1.61–2.76) for those with LDL cholesterol =135 mg/dl, respectively. The adjusted HR of very-high-risk
CKD for all-cause mortality was 4.44 (95% CI, 2.31–8.53) in aged b75 years and 1.80 (95% CI, 1.19–2.72) in
aged ≥75 years.
Conclusions: We found a high prevalence of CKD and a low prevalence of albuminuria in a Spanish cohort of T2DM patients attended in the primary care setting. The prevalence of CKD at baseline was significantly higher in women than in men, but CKD-associated mortality was higher in men than in women. Approximately half of
the deaths were due to cardiovascular causes. Baseline CKD is an independent risk factor for all-cause and cardiovascular mortality in the overall cohort, as well in separate subsamples of men and women and in subsamples of primary and secondary prevention of coronary heart disease. Albuminuria is an independent risk factor for all-cause and cardiovascular mortality only in primary prevention.
Classifying patients by prognosis stage based on eGFR and albuminuria revealed that low-risk patients had the highest all-cause mortality-free survival rate and cardiovascular mortality-free survival rate.