Aortic stiffness and ambulatory blood pressure as predictors of diabetic kidney disease: a competing risks analysis from the Rio de Janeiro Type 2 Diabetes Cohort Study

Cardoso, Claudia R.L.; Leite, Nathalie C.; Salles, Guilherme C.; Ferreira, Marcel T.; Salles, Gil F.

doi:10.1007/s00125-017-4484-z

Cited by 28 publications

(37 citation statements)

References 45 publications

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“…28 Moreover, there are several studies showing that diabetes is associated with the development of increased albuminuria and faster progression of CKD. 28 30-32 Evidence from other Latin American countries [30][31][32] suggests that diabetes and worse glycaemic control are significant predictors for increased albuminuria, faster progression of CKD and need for RRT. On the other hand, a meta-analysis which analysed the risk factors for development and progression of CKD, showed that diabetes was marginally predictive of progression from late-stage CKD to ESKD (HR: 1.16, 95% CI: 0.98 to 1.38; p = 0.08).…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009–2010 and 2016–2017

et al. 2020

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ObjectivesThis study estimates the prevalence of chronic kidney disease (CKD) among Chilean adults and examines its associations with sociodemographic characteristics, health behaviours and comorbidities.DesignAnalysis of cross-sectional data from the two most recent large nationally representative Chilean Health Surveys (Encuesta Nacional de Salud, ENS) 2009–2010 and 2016–2017.ParticipantsAdults aged 18+ years with serum creatine data (ENS 2009–2010: n=4583; ENS 2016–2017: n=5084).Primary and secondary outcome measuresReduced kidney function (CKD stages 3a–5) based on the estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) was the primary outcome measure. Using the urine albumin-to-creatinine ratio (ACR ≥30 mg/g), increased albuminuria was ascertained among adults aged 40+ years with diabetes and/or hypertension. Both outcomes were analysed using logistic regression with results summarised using OR. CKD prevalence (stages 1–5) among adults aged 40+ years was estimated including participants with an eGFR of >60 mL/min/1.73 m2 but with increased albuminuria (stages 1–2).ResultsOverall, 3.2% (95% CI: 2.4% to 3.8%) of adults aged 18+ in ENS 2016–2017 had reduced kidney function. After full adjustment, participants with hypertension (OR: 2.37; 95% CI: 1.19 to 4.74) and those with diabetes (OR: 1.66; 95% CI: 1.03 to 2.66) had significantly higher odds of reduced kidney function. In ENS 2016–2017, 15.5% (13.5% to 17.8%) of adults aged 40+ years with diabetes and/or hypertension had increased albuminuria. Being obese versus normal-weight (OR: 1.66; 95% CI: 1.08 to 2.54) and having both diabetes and hypertension versus having diabetes alone (OR: 2.30; 95% CI: 1.34 to 3.95) were significantly associated with higher odds of increased albuminuria in fully-adjusted analyses. At least 15.4% of adults aged 40+ years in ENS 2016–2017 had CKD (stages 1–5), including the 9.6% of adults at CKD stages 1–2.ConclusionsPrevention strategies and Chilean guidelines should consider the high percentage of adults aged 40 years and older at CKD stages 1–2.

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Section: Discussionmentioning

confidence: 99%

Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009–2010 and 2016–2017

et al. 2020

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“…All participants gave written informed consent, and the local Ethics Committee had previously approved the study protocol. The characteristics of this cohort, the baseline procedures and the diagnostic definitions have been described previously [29][30][31][32][33]. In summary, inclusion criteria were all adult type 2 diabetic individual up to 80 years old with either any microvascular (retinopathy, nephropathy or neuropathy) or macrovascular (coronary, cerebrovascular or peripheral artery disease) complication, or with at least two other modifiable cardiovascular risk factors (hypertension, dyslipidemia or current smoking).…”

Section: Participants and Baseline Proceduresmentioning

confidence: 99%

“…All participants were submitted to a standard baseline protocol that included a thorough clinicallaboratory evaluation. Diagnostic criteria for diabetic chronic complications were detailed previously [29][30][31][32][33]. In brief, coronary heart disease was diagnosed by clinical or electrocardiographic criteria, confirmed by positive ischemic stress tests.…”

Section: Participants and Baseline Proceduresmentioning

confidence: 99%

“…Macrovascular and mortality endpoints were ascertained from medical records (most non-fatal and fatal in-hospital events were attended at our hospital), death certificates and interviews with attending physicians and patient families, using a standard questionnaire reviewed by two independent observers. Microvascular outcomes were retinopathy development or worsening [32], renal outcomes [33] (new microalbuminuria development, and renal function deterioration [defined as doubling of serum creatinine or end-stage renal failure needing dialysis or death from renal failure], and a composite of them), and peripheral neuropathy development or worsening [31]. Retinopathy and renal outcomes were evaluated by annual examinations [32,33], whereas peripheral neuropathy was evaluated on two serial specific examinations performed after a median of 6 and 10 years from the baseline examination [31,34].…”

Section: Follow-up and Outcomes Assessmentmentioning

confidence: 99%

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Prognostic importance of visit-to-visit blood pressure variability for micro- and macrovascular outcomes in patients with type 2 diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study

Cardoso

Leite

Salles

2020

Cardiovasc Diabetol

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Background: The prognostic importance of an increased visit-to-visit blood pressure variability (BP-VVV) for the future development of micro-and macrovascular complications in type 2 diabetes has been scarcely investigated and is largely unsettled. We aimed to evaluate it in a prospective long-term follow-up study with 632 individuals with type 2 diabetes. Methods: BP-VVV parameters (systolic and diastolic standard deviations [SD] and variation coefficients) were measured during the first 24-months. Multivariate Cox analysis, adjusted for risk factors and mean BP levels, examined the associations between BP-VVV and the occurrence of microvascular (retinopathy, microalbuminuria, renal function deterioration, peripheral neuropathy) and macrovascular complications (total cardiovascular events [CVEs], major adverse CVEs [MACE] and cardiovascular and all-cause mortality). Improvement in risk discrimination was assessed by the C-statistic and integrated discrimination improvement (IDI) index. Results: Over a median follow-up of 11.3 years, 162 patients had a CVE (132 MACE), and 212 patients died (95 from cardiovascular diseases); 153 newly-developed or worsened diabetic retinopathy, 193 achieved the renal composite outcome (121 newly-developed microalbuminuria and 95 deteriorated renal function), and 171 newly-developed or worsened peripheral neuropathy. Systolic BP-VVV was an independent predictor of MACE (hazard ratio: 1.25, 95% CI 1.03-1.51 for a 1-SD increase in 24-month SD), but not of total CVEs, cardiovascular and all-cause mortality, and of any microvascular outcome. However, no BP-VVV parameter significantly improved cardiovascular risk discrimination (increase in C-statistic 0.001, relative IDI 0.9%). Conclusions: Systolic BP-VVV was an independent predictor of MACE, but it did not improve cardiovascular risk stratification. The goal of anti-hypertensive treatment in patients with type 2 diabetes shall remain in controlling mean BP levels, not on decreasing their visit-to-visit variability.

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“…Previous observation trials have shown that an abrupt morning BP surge on waking and a dramatic BP drop at night (10%–20%) correlate with major adverse cardiovascular events [ 7 – 9 ]. Thus, BP, HR, and autonomic dysfunction (mixture of sympathetic and vagal activity) variability could be significantly associated with clinical cardiovascular disease (CVD) risk factors, such as age, sex, body mass index, serum glucose level, serum insulin level, and cholesterol level that reflect metabolic and autonomic abnormalities [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Circadian Variation in 24-Hour Ambulatory Blood Pressure, Heart Rate, and Sympathetic Tone Correlate with Cardiovascular Disease Risk: A Cluster Analysis

Hyun

Kang

Kim

et al. 2020

Cardiovascular Therapeutics

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To investigate whether specific time series patterns for blood pressure (BP), heart rate (HR), and sympathetic tone are associated with metabolic factors and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). A total of 989 patients who underwent simultaneous 24-hour ambulatory BP and Holter electrocardiogram monitoring were enrolled. The patients were categorized into sixteen groups according to their circadian patterns using the consensus clustering analysis method. Metabolic factors, including cholesterol profiles and apolipoprotein, were compared. The 10-year ASCVD risk was estimated based on the Framingham risk model. Overall, 16 significant associations were found between the clinical variables and cluster groups. Age was commonly associated with all clusters in systolic BP (SBP), diastolic BP (DBP), HR, and sympathetic tone. Metabolic indicators, including diabetes, body mass index, total cholesterol, high-density lipoprotein, and apolipoprotein, were associated with the four sympathetic tone clusters. In the crude analysis, the ASCVD risk increased incrementally from clusters 1 to 4 across SBP, DBP, HR, and sympathetic tone. After adjustment for multiple variables, however, only sympathetic tone clusters 3 and 4 showed a significantly high proportion of patients at high risk (≥7.5%) of 10-year ASCVD (odds ratio OR=5.90, 95% confidential interval CI=1.27–27.46, and P value = 0.024 and OR=15.28, 95% CI=3.59–65.11, and P value < 0.001, respectively). Time series patterns of BP, HR, and sympathetic tone can serve as an indicator of aging. Circadian variations in sympathetic tone can provide prognostic information about patient metabolic profiles and indicate future ASCVD risk.

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Aortic stiffness and ambulatory blood pressure as predictors of diabetic kidney disease: a competing risks analysis from the Rio de Janeiro Type 2 Diabetes Cohort Study

Cited by 28 publications

References 45 publications

Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009–2010 and 2016–2017

Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009–2010 and 2016–2017

Prognostic importance of visit-to-visit blood pressure variability for micro- and macrovascular outcomes in patients with type 2 diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study

Patterns of Circadian Variation in 24-Hour Ambulatory Blood Pressure, Heart Rate, and Sympathetic Tone Correlate with Cardiovascular Disease Risk: A Cluster Analysis

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