Sudomotor dysfunction independently predicts incident cardiovascular–renal events and all-cause death in type 2 diabetes: the Joint Asia Diabetes Evaluation register

Autor: Kong Aps, Risa Ozaki, Luk Aoy, Fu Awc, Lau Esh, Chan Jcn, Cheung Kkt, Ma Rcw, Lim Ll
Rok vydání: 2018
Předmět:
Male
autonomic dysfunction
030232 urology & nephrology
Kaplan-Meier Estimate
Type 2 diabetes
030204 cardiovascular system & hematology
Kidney
0302 clinical medicine
Diabetic Neuropathies
Risk Factors
Interquartile range
Electrochemistry
Prospective Studies
Registries
Child
Prospective cohort study
Skin
Hazard ratio
Middle Aged
Cardiovascular Diseases
Nephrology
Area Under Curve
Child
Preschool
Cohort
Disease Progression
Female
Cohort study
Adult
medicine.medical_specialty
Asia
Adolescent
03 medical and health sciences
Asian People
Clinical Research
Internal medicine
cohort study
medicine
Humans
Mortality
Renal Insufficiency
Chronic
Risk factor
Aged
Proportional Hazards Models
Transplantation
business.industry
Electric Conductivity
medicine.disease
Diabetes Mellitus
Type 2
ORIGINAL ARTICLES
business
chronic kidney disease
Follow-Up Studies
Kidney disease
Zdroj: Nephrology Dialysis Transplantation
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/gfy154
Popis: BackgroundEarly detection and risk factor control prevent chronic kidney disease (CKD) progression. Evaluation of peripheral autonomic dysfunction may detect incident cardiovascular–renal events in type 2 diabetes (T2D).MethodsSUDOSCAN, a non-invasive tool, provides an age-adjusted electrochemical skin conductance (ESC) composite score incorporating hands/feet ESC measurements, with a score ≤53 indicating sudomotor dysfunction. A consecutive cohort of 2833 Chinese adults underwent structured diabetes assessment in 2012–13; 2028 participants without preexisting cardiovascular disease (CVD) and CKD were monitored for incident cardiovascular–renal events until 2015.ResultsIn this prospective cohort {mean age 57.0 [standard deviation (SD) 10.0] years; median T2D duration 7.0 [interquartile range (IQR) 3.0–13.0] years; 56.1% men; 72.5% never-smokers; baseline ESC composite score 60.7 (SD 14.5)}, 163 (8.0%) and 25 (1.2%) participants developed incident CKD and CVD, respectively, after 2.3 years of follow-up. The adjusted hazard ratios (aHRs) per 1-unit decrease in the ESC composite score for incident CKD, CVD and all-cause death were 1.02 [95% confidence interval (CI) 1.01–1.04], 1.04 (1.00–1.07) and 1.04 (1.00–1.08), respectively. Compared with participants with an ESC composite score >53, those with a score ≤53 had an aHR of 1.56 (95% CI 1.09–2.23) for CKD and 3.11 (95% CI 1.27–7.62) for CVD, independent of common risk markers. When added to clinical variables (sex and duration of diabetes), the ESC composite score improved discrimination of all outcomes with appropriate reclassification of CKD risk.ConclusionsA low ESC composite score independently predicts incident cardiovascular–renal events and death in T2D, which may improve the screening strategy for early intervention.
Databáze: OpenAIRE
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