Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study

Abstract

CKD is a major contributor to excess mortality in type 2 diabetes, conferring a very high risk in younger patients and fully accounting for excess risk in the older ones. Higher albuminuria and lower eGFR, even in the normal range, identify individuals with increased mortality risk. Trial registration ClinicalTrials.gov (NCT00715481; https://clinicaltrials.gov/ct2/show/NCT00715481 ).

Glomerular Filtration Rate and Associated Risks of Cardiovascular Events, Mortality, and Severe Hypoglycemia in Patients with Type 2 Diabetes: Secondary Analysis (DEVOTE 11)

“…This finding might be explained by the high burden of CVD in this population (71.7%) and the persistently high risk of cardiovascular death, accounting for 63-69% of all deaths across baseline GFR categories G2-G5. Indeed, a prior study of the contributions of CVD and CKD to all-cause mortality in patients with T2D found that CVD had the strongest association with risk of allcause mortality in patients with and without CKD [23]. However, results in the present study demonstrate that prior CVD and prior CKD were similarly associated with risk of all-cause mortality and, if anything, prior CKD had the strongest association.…”

“…If any aspect of the observed association between baseline GFR and risk of all-cause mortality (as reported in the present and previous studies [17,18,20,21,23,36]) are causally connected (in other words, not an epiphenomenon), efforts to identify and limit the progression of CKD need to be pushed to the forefront of clinical care. The treatment of patients with T2D and at high risk of developing CVD or CKD is complex.…”

“…Antihyperglycemic medications in patients with differing levels of renal function can affect treatment efficacy and safety; for instance, they can lead to an increased risk of hypoglycemia [11] and/or increased risks of cardiovascular events and mortality [17][18][19][20][21][22][23], resulting in product-label cautions, warnings, and contraindications [11,24]. As patients with a lower glomerular filtration rate (GFR) tend to have a higher burden of CVD, a longer duration of T2D, and more commonly require insulin therapy [11,14], there is a need to better understand the relationships between CKD and CVD risk factors, outcomes, and the use of medications in this population (particularly those with severe CKD who have been excluded from most trials) [11].…”

Effectiveness of dapagliflozin versus comparators on renal endpoints in the real world: A multicentre retrospective study

“…CKD is highly prevalent in T2D and is a strong accelerator of cardiovascular risk . In the longitudinal Italian Renal Insufficiency and Cardiovascular Events (RIACE) study, higher AER and lower eGFR, even in the normal range, identified individuals with increased mortality . Other observational studies and meta‐analyses show that an excess cardiovascular morbidity and mortality is linked to impaired renal function .…”

“…11 In the longitudinal Italian Renal Insufficiency and Cardiovascular Events (RIACE) study, higher AER and lower eGFR, even in the normal range, identified individuals with increased mortality. 12 Other observational studies and meta-analyses show that an excess cardiovascular morbidity and mortality is linked to impaired renal function. 13,14 Therefore, it has been hypothesized that kidney protection contributes to cardiovascular protection in patients treated with SGLT2i.…”