TY - JOUR
T1 - Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes
AU - Ninomiya, Toshiharu
AU - Perkovic, Vlado
AU - De Galan, Bastiaan E.
AU - Zoungas, Sophia
AU - Pillai, Avinesh
AU - Jardine, Meg
AU - Patel, Anushka
AU - Cass, Alan
AU - Neal, Bruce
AU - Poulter, Neil
AU - Mogensen, Carl Erik
AU - Cooper, Mark
AU - Marre, Michel
AU - Williams, Bryan
AU - Hamet, Pavel
AU - Mancia, Giuseppe
AU - Woodward, Mark
AU - MacMahon, Stephen
AU - Chalmers, John
PY - 2009/8
Y1 - 2009/8
N2 - There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m2 at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.
AB - There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m2 at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.
UR - http://www.scopus.com/inward/record.url?scp=68149170224&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68149170224&partnerID=8YFLogxK
U2 - 10.1681/ASN.2008121270
DO - 10.1681/ASN.2008121270
M3 - Article
C2 - 19443635
AN - SCOPUS:68149170224
SN - 1046-6673
VL - 20
SP - 1813
EP - 1821
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 8
ER -