Albuminuric and non-albuminuric chronic kidney disease in type 1 diabetes: Association with major vascular outcomes risk and all-cause mortality.
J Diabetes Complications
; 32(6): 550-557, 2018 06.
Article
in En
| MEDLINE
| ID: mdl-29705091
ABSTRACT
AIMS:
Albuminuric and non-albuminuric phenotypes of chronic kidney disease (CKD) may have different cardiovascular risk and survival in type 1 diabetes (T1DM). Herein we estimated risk of major vascular outcomes by the EURODIAB PCS score and determined all-cause mortality rate in 774 T1DM according to CKD phenotypes.METHODS:
We evaluated the distribution of CKD phenotypes [no CKD, stages 1-2, non-albuminuric stage ≥3 (Alb-CKD), albuminuric stage ≥3 (Alb+CKD)], the EURODIAB risk score for major vascular outcomes [low- (LS), intermediate- (IS), and high- (HS) risk] and all-cause mortality over a follow-up of 8.25⯱â¯2.34â¯years.RESULTS:
Out of 774 subjects, 692 (89.4%) had no CKD, 53 (6.8%) CKD stages 1-2, 17 (2.2%) Alb-CKD and 12 (1.6%) Alb+CKD; 466 (60.2%) had LS, 205 (26.5%) IS and 103 (13.3%) HS. Distribution of HS was no CKD, 9.1%; CKD stages 1-2, 34.0%; Alb-CKD, 64.7%; Alb+CKD, 91.7% (Pâ¯<â¯0.0001). Mortality increased from no CKD, 3.0%; to stages 1-2, 15.1% (HR 4.504); Alb-CKD, 29.4% (8.573); Alb+CKD, 50.0% (20.683, Pâ¯<â¯0.0001). Accounting for age and sex, HRs for mortality compared to no CKD were CKD stages 1-2, 3.84 (Pâ¯=â¯0.001); Alb-CKD, 2.97 (Pâ¯=â¯0.046); Alb+CKD, 7.44 (Pâ¯<â¯0.0001). Adjusting for sex and the EURODIAB score, HRs for mortality compared to no CKD were CKD stages 1-2, 2.57 (Pâ¯=â¯0.027); Alb-CKD, 2.77 (Pâ¯=â¯0.058); Alb+CKD, 4.58 (Pâ¯=â¯0.003).CONCLUSIONS:
In our T1DM cohort, one fifth of those with CKDs were non-albuminuric. This phenotype was associated with higher risk of major outcomes and similar rate of mortality as compared to CKD stages 1-2. The greatest risk and highest mortality occur in patients with Alb+CKD.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiovascular Diseases
/
Mortality
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Diabetes Mellitus, Type 1
/
Diabetic Angiopathies
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Diabetic Nephropathies
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Albuminuria
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Renal Insufficiency, Chronic
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Diabetes Complications
Journal subject:
ENDOCRINOLOGIA
Year:
2018
Document type:
Article
Affiliation country:
Italia