Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies
| Autor: | Michele Provenzano, Carlo Garofalo, Domenico Santoro, Giuseppe Conte, Paolo Chiodini, Ferdinando Carlo Sasso, Silvio Borrelli, Francis B. Gabbai, Luca De Nicola, Roberto Minutolo, Vincenzo Bellizzi |
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| Přispěvatelé: | Minutolo, Roberto, Gabbai, Francis B, Provenzano, Michele, Chiodini, Paolo, Borrelli, Silvio, Garofalo, Carlo, Sasso, Ferdinando C, Santoro, Domenico, Bellizzi, Vincenzo, Conte, Giuseppe, De Nicola, Luca |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Renal function 030204 cardiovascular system & hematology urologic and male genital diseases Gastroenterology 03 medical and health sciences 0302 clinical medicine Meta-Analysis as Topic Diabetes mellitus Internal medicine Risk of mortality Humans Medicine Diabetic Nephropathies Prospective Studies 030212 general & internal medicine Renal Insufficiency Chronic Prospective cohort study Aged Transplantation Proteinuria business.industry Case-control study Keywords: cardiovascular risk chronic kidney disease diabetes mellitus ESRD proteinuria Middle Aged Prognosis medicine.disease female genital diseases and pregnancy complications Cardiovascular Diseases Nephrology Case-Control Studies Kidney Failure Chronic Moderate proteinuria Female medicine.symptom business Glomerular Filtration Rate Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation. 33:1942-1949 |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | No study has assessed whether the prognosis of coexisting diabetes mellitus and chronic kidney disease (DM-CKD) is dictated by DM per se or by the extent of proteinuria.In this pooled analysis of four prospective studies in CKD patients treated with drugs inhibiting the renin-angiotensin system, we compared the risk of all-cause mortality, fatal and non-fatal cardiovascular (CV) events and end-stage renal disease (ESRD) between patients with (n = 693) and without diabetes (n = 1481) stratified by proteinuria level (0.15, 0.15-0.49, 0.5-1 and 1 g/day).The group with DM-CKD was older (69 ± 11 versus 65 ± 15 years), had a higher body mass index (29.6 ± 5.4 versus 27.5 ± 4.8 kg/m2) and systolic blood pressure (143 ± 19 versus 136 ± 18 mmHg), prevalent CV disease (48% versus 29%) and lower estimated glomerular filtration rate (34.5 ± 17.9 versus 36.6 ± 19.0 mL/min/1.73 m2). During 4.07 years of follow-up, there were 466 patients with ESRD, 334 deaths and 401 CV events occurred. In the subgroup with urine protein0.15 g/day (N = 662), the risks of ESRD, CV events and mortality were similar in diabetic and non-diabetic patients. Conversely, in DM-CKD patients, the mortality risk was higher in proteinuric patients {hazard ratio 1.92 [95% confidence interval (CI) 1.25-2.95); 1.99 (1.26-3.15) and 1.98 (1.28-3.06) for proteinuria 0.15-0.49, 0.5-1 and1 g/day, respectively}, whereas in non-diabetics the mortality risk increased only for proteinuria 0.5-1 g/day [HR 1.60 (95% CI 1.07-2.40)] and1 g/day [HR 1.69 (95% CI1.20-2.55)]. In both groups, CV risk had a trend similar to that of mortality. ESRD risk increased progressively across strata0.5 g/day independent of diabetic status.We provide evidence that patients with non-proteinuric DM-CKD are not exposed to higher cardiorenal risk. In contrast, in the presence of moderate proteinuria and diabetes per se is associated with a higher risk of mortality and CV events, whereas the entity of abnormal proteinuria modulates ESRD risk independent of diabetes. |
| Databáze: | OpenAIRE |
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