A novel kidney disease index reflecting both the albumin-to-creatinine ratio and estimated glomerular filtration rate, predicted cardiovascular and kidney outcomes in type 2 diabetes

Abstract

Background The estimated glomerular filtration rate (eGFR) and the albumin-to-creatinine ratio (ACR) are risk factors for diabetes-related outcomes. A composite that captures information from both may provide a simpler way of assessing risk. Methods 9115 of 9901 Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) participants with both an ACR and eGFR at baseline were included in this post hoc epidemiologic analysis. The hazard of higher baseline levels of 1/eGFR and natural log transformed ACR (calculated as ln [ACR × 100] to eliminate negative values) and their interaction for incident major adverse cardiovascular events (MACE), kidney outcomes, and deaths was estimated. The hazard of the geometric mean of these two baseline measures (the kidney disease index or KDI) was also assessed. Results A non-linear relationship was observed between 1/eGFR and all three outcomes, and between ln [ACR × 100] and the kidney outcome. There was also a negative interaction between these two risk factors with respect to MACE and death. Conversely, a linear relationship was noted between the KDI and all three outcomes. People in the highest KDI fifth experienced the highest incidence of MACE, death, and the kidney outcome (4.43, 4.56, and 5.55/100 person-years respectively). C statistics for the KDI were similar to those for eGFR and albuminuria. Conclusions The KDI combines the baseline eGFR and ACR into a novel composite risk factor that has a simple linear relationship with incident serious outcomes in people with diabetes and additional CV risk factors. Trial Registration clinicaltrials.gov NCT01394952.

Cardiovascular and renal outcomes with varying degrees of kidney disease in high‐risk people with type 2 diabetes: An epidemiological analysis of data from the AMPLITUDE‐O trial

“…These findings are consistent with previous epidemiological analyses of data from the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial, in which the UACR was also the strongest determinant of incident MACE and a composite kidney outcome 7 . In those analyses however, the eGFR and UACR were not independent determinants of incident MACE but were independent determinants of a very similar kidney composite outcome.…”

Association of the longitudinal trajectory of urinary albumin/creatinine ratio in diabetic patients with adverse cardiac event risk: a retrospective cohort study

“…The authors developed a novel prognostic indicator that combined uACR and eGFR, called the kidney disease index (KDI). The primary outcome was to evaluate the baseline levels of 1/eGFR and natural log-transformed uACR (calculated as ln[uACR × 100]) and their interactions for MACE, kidney outcomes, and death ( 20 ). The study found a nonlinear association between 1/eGFR and all three prognoses and between ln[uACR × 100] and kidney outcomes, but a negative relationship between 1/eGFR and uACR and MACE.…”

Exploring the Relationship Between Efpeglenatide Dose and Cardiovascular Outcomes in Type 2 Diabetes: Insights From the AMPLITUDE-O Trial

“…Continuous variables were collected at baseline and ≥5 times afterward (at 3, 6, 12, 18, and 24 months). Finally, 2 additional outcomes were assessed for these analyses; these were the previously reported kidney disease index, calculated as a geometric mean of 1/eGFR and Ln(100×albumin:creatinine ratio), 13 and a new categorical outcome of optimal diabetes control, defined as the first occurrence of an HbA1c of <7% in the absence of any weight gain or episode of severe hypoglycemia.…”